Abstract
BACKGROUND: Transfemoral access is the preferred route for transcatheter aortic valve replacement (TAVR), but severe calcification and luminal narrowing of the iliofemoral artery or abdominal aorta may preclude safe large-bore sheath passage. Intravascular lithotripsy (IVL) has been increasingly used for iliofemoral vessel preparation, yet its application in the abdominal aorta has been rarely reported. CASE SUMMARY: An 84-year-old woman with symptomatic severe aortic stenosis was deemed high risk for transfemoral TAVR owing to severe narrowing with circumferential calcification of infrarenal aorta with luminal diameter <5 mm. To preserve transfemoral access, IVL with a 7.0-mm Shockwave balloon was performed using stepwise low-pressure inflations (1-6 atm, 300 pulses), achieving adequate luminal expansion for an 18-F sheath. A 23-mm self-expanding valve was successfully implanted without complications, and the patient was discharged the next day. DISCUSSION: This case demonstrates that IVL can safely modify a small-caliber, circumferentially calcified iliofemoral and abdominal aorta to facilitate transfemoral TAVR. TAKE-HOME MESSAGE: Stepwise low-pressure inflations and meticulous procedural planning may expand the feasibility of transfemoral access in patients otherwise considered for higher-risk alternative routes.