Behind The Knife: The Surgery Podcast28 Syys

Journal Review in Vascular Surgery: Disrupt PAD III: Intravascular Lithotripsy for Calcified Peripheral Artery Disease

Calcified peripheral artery disease (PAD) remains one of the most challenging problems in endovascular intervention. Calcium limits vessel expansion, increases the risk of dissection and procedural failure, and can ultimately lead to bailout stenting. The Disrupt PAD III program provided important evidence for a different approach: intravascular lithotripsy (IVL) as a vessel-preparation strategy. In this episode, we examine the randomized Disrupt PAD III trial published by Tepe and colleagues and the large, real-world observational analysis led by Armstrong and colleagues. Together, these studies explore whether IVL can make treatment of heavily calcified lesions more predictable, reduce the need for stenting, and support a “leave-nothing-behind” strategy.

Hosts:
Dr. Robert Beaulieu
Dr. Frank Davis
Dr. Luciano Delbono
Dr. Andrew Huang
Dr. Carolyn Judge

Learning Objectives
By the end of this episode, listeners should be able to:

Explain the challenges posed by moderate to severe vascular calcification during peripheral endovascular intervention and the rationale for dedicated vessel-preparation strategies.
Describe the design, patient population, endpoints, and primary findings of the randomized Disrupt PAD III trial comparing IVL with conventional PTA.
Interpret the procedural and longer-term outcomes associated with IVL, including residual stenosis, dissection rates, bailout stenting, and primary patency.
Evaluate how the Disrupt PAD III observational study complements the randomized trial by examining IVL in a larger, more complex, real-world population and across multiple vascular beds.
Identify the practical implications, limitations, and remaining unanswered questions surrounding IVL, including its role relative to other calcium-modification strategies such as atherectomy.

References

Tepe G, Brodmann M, Werner M, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Randomized Disrupt PAD III Trial. JACC Cardiovasc Interv. 2021;14(12):1352-1361. doi:10.1016/j.jcin.2021.04.010. https://pubmed.ncbi.nlm.nih.gov/34167675/
Tepe G, Brodmann M, Bachinsky W, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: Mid-term Outcomes From the Randomized Disrupt PAD III Trial. J Soc Cardiovasc Angiogr Interv. 2022. https://pubmed.ncbi.nlm.nih.gov/39131928/
Armstrong EJ, Adams G, Soukas PA, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Disrupt PAD III Observational Study. J Endovasc Ther. 2026;33(2):853-862. doi:10.1177/15266028241283716. https://pubmed.ncbi.nlm.nih.gov/39422234/

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