{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T14:53:03Z","timestamp":1791039183421,"version":"4.1.0"},"reference-count":18,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100031956","name":"shockwave medical","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100031956","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To establish pan-European expert consensus on the use of Shockwave intravascular lithotripsy (IVL) for endovascular treatment of calcified iliac steno-occlusive disease and to develop a pragmatic, expert-derived treatment algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>A modified Delphi process comprised an initial workshop, 2 anonymous online surveys and a final workshop. Experts were purposively identified through professional networks using prespecified procedural-volume and IVL-experience criteria. Round 1 combined closed questions with unrestricted free text; thematic and framework analysis informed refinement, separation or removal of candidate items for round 2. Agreement was reported as the proportion supporting each statement, with consensus defined a priori as \u226570%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twenty-six experts completed round 1 and 17 completed round 2 (65% retention); reasons for non-participation in round 2 were not collected. Vascular surgeons comprised 65% of the round 1 panel, and approximately 65% of participants practised in Italy. Sixteen final statements achieved 73% to 100% agreement. Key items supported computed tomographic angiography with duplex ultrasound (100%), planned rather than bailout IVL use (100%), calcium burden as the principal determinant (93%), and selective rather than routine intravascular imaging (93%). The final workshop approved the algorithm; item-level agreement is displayed within it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This modified Delphi study provides a structured expert consensus and algorithm for Shockwave IVL in iliac arteries. It is an expert-opinion framework that should complement, not replace, patient-specific clinical judgement, device instructions for use and local guidance, and it requires prospective external validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Impact<\/jats:title>\n                    <jats:p>This pan-European modified Delphi study reports expert-agreed statements on planned Shockwave IVL use, imaging, technique, adjunctive treatment and follow-up in calcified iliac disease. The algorithm displays the agreement strength for each recommendation and can support structured multidisciplinary decision-making where comparative evidence is limited. It represents expert opinion rather than a guideline. The algorithm should be applied alongside clinical judgement and device instructions for use. The consensus identified calcium definition, comparative IVL effectiveness assessment, and research priorities in this area.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028261489153","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:18:47Z","timestamp":1790777927000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["International European Expert Consensus on the Use of Shockwave Intravascular Lithotripsy in Iliac Arteries: A Modified Delphi Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3399-094X","authenticated-orcid":false,"given":"Athanasios","family":"Saratzis","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, UK"},{"name":"University of Leicester &amp; NIHR Leicester Biomedical Research Centre, Glenfield Hospital, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Fazzini","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Tor Vergata University, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/aet2.10645"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/15266028241266417"},{"key":"e_1_3_4_4_2","article-title":"Use of vessel preparation in endovascular peripheral arterial disease (PAD) Interventions: a global qualitative analysis","volume":"19","author":"Saratzis A","year":"2026","unstructured":"Saratzis A, Patrone L, Secemsky EA, et al. Use of vessel preparation in endovascular peripheral arterial disease (PAD) Interventions: a global qualitative analysis. J Endovasc Ther. 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