{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T22:44:44Z","timestamp":1777848284267,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"abstract":"<jats:p>This study reports our experience with intravascular lithotripsy (IVL) in managing heavily calcified peripheral arterial disease (PAD) at a tertiary center in Southeast Asia. A total of 50 procedures were performed in 49 patients between October 2022 and April 2024. The cohort had a high burden of comorbidities, with 94% presenting with chronic limb-threatening ischemia, 62% classified as wound, ischemia, and foot infection (WIfI) stage 4, and 31% having end-stage renal failure. Severe vascular calcification (Peripheral Artery Calcification Scoring System [PACSS] grade 4) was present in 84% of lesions. IVL was employed as a vessel preparation strategy prior to definitive treatment, with adjunctive therapies used in all cases. Technical success was achieved in 100% of procedures, with a mean luminal gain of 71.4%\u00b121.8%. Bailout stenting was required in 16% of cases, and there were no incidents of distal embolization. At 1-year follow-up, the target lesion revascularization rate was 6.1%, the overall reintervention rate was 14%, limb salvage was 84%, and mortality was 31%. Our findings suggest that IVL is a safe and effective option for vessel preparation in patients with severely calcified PAD, achieving high technical success and favorable mid-term outcomes in a complex, high-risk population.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Clinical Impact<\/jats:title>\n                    <jats:p>Calcified peripheral arterial disease remains a challenging subset in endovascular therapy, often limiting luminal gain, increasing dissection risk, and impairing drug delivery. This single-center experience demonstrates that IVL is a safe and effective vessel-preparation strategy in a real-world population with high comorbidity burden and predominantly PACSS grade 4 disease. IVL achieved 100% technical success, substantial luminal gain, low complication rates; and favorable 1-year limb salvage and reintervention outcomes. These findings support IVL as a practical method for modifying severe calcification and improving procedural reliability in high-risk patients undergoing endovascular treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028251399111","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T11:46:36Z","timestamp":1767095196000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cracking the Calcium Barrier: Intravascular Lithotripsy for Peripheral Arterial Disease\u20141-year Outcomes From 50 Procedures in a Singapore Tertiary Hospital"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5291-4961","authenticated-orcid":false,"given":"Sean Yao Zu","family":"Kong","sequence":"first","affiliation":[{"name":"Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore"},{"name":"Duke-NUS Medical School, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anton Amirthanathan","family":"Jenil","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6097-6721","authenticated-orcid":false,"given":"Enhui","family":"Yong","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Science, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lester Rhan Chaen","family":"Chong","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3711-0946","authenticated-orcid":false,"given":"Malcolm Han Wen","family":"Mak","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiantai","family":"Hong","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2677-4341","authenticated-orcid":false,"given":"Glenn Wei Leong","family":"Tan","sequence":"additional","affiliation":[{"name":"Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Wei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gavin","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence Han Hwee","family":"Quek","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uei","family":"Pua","sequence":"additional","affiliation":[{"name":"Department of 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Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-33745-6_14"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2023.02.015"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v12.i6.827"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.116.306258"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.06.086"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.86.1.64"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tvir.2022.100841"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.10344"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12928-018-0553-6"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-20-01000"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-18-01056"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2023.12.104"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2020.06.015"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/15266028221075563"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2020.551861"},{"issue":"4","key":"e_1_3_2_17_2","first-page":"271","article-title":"Strategies 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