Application of intravascular lithotripsy in a case of severely calcified arteriovenous fistula stenosis: A case report and technical note.

BACKGROUND

Severe calcification-associated stenosis of arteriovenous fistula (AVF) poses a significant challenge in the maintenance of hemodialysis access. Conventional balloon dilation often faces issues such as incomplete dilation and high complication rates. Intravascular lithotripsy (IVL) has been widely applied in coronary and peripheral artery fields, but its application for AVF calcification remains limited, with only a few technical reports available.

METHODS

We present a case of severe circumferential calcification and stenosis of a radiocephalic arteriovenous fistula treated with IVL.

RESULTS

During the procedure, the calcified area was subjected to multiple pulsed impacts using a shockwave balloon, which was successfully performed without complications such as vascular rupture or dissection. Immediate post-procedural angiography showed significant improvement in stenosis, and a 3-month follow-up ultrasound confirmed sustained patency of the lumen, with a significant reduction in calcified plaques and with blood flow velocity increasing from 180 to 420 cm/s.

CONCLUSION

This case demonstrates the safety and feasibility of IVL for severe calcification in AVFs, offering a new effective option for managing such complex lesions. However, long-term efficacy requires further study.