Professor Zhuang Hui's Team Reports First-in-Nation Clinical Application of DEEPQUAKE Peripheral Intravascular Lithotripsy System for Diabetic Foot Revascularization

Patient:73 years old, female.

Chief Complaint:"Right lower limb claudication for more than 3 years, right foot sole ulcer and gangrene for more than half a month" admitted to the hospital, Day 4.

History of Present Illness:Two years ago, the patient developed intermittent claudication in the right lower limb without obvious cause. Half a month ago, an ulcer appeared on the sole of the right foot with severe pain and poor response to medication. The patient then visited our outpatient department and was admitted to the hospital with a diagnosis of "atherosclerotic occlusion of the lower extremity arteries and diabetic foot." During the course of the disease, the patient had poor appetite and sleep, general mental state, reduced urine output, normal bowel movements, and reported slight weight loss.

Past Medical History:Type 2 Diabetes Mellitus (>10 years, insulin + oral medication), Chronic Renal Insufficiency, Coronary Heart Disease with Chronic Heart Failure, Refractory Hypertension (left renal artery stent half a month ago), Extensive Atherosclerosis.

Physical Examination:Patient is conscious, appears anemic, and in fair spirits, reports poor appetite: Abdomen is soft, with mild tenderness in the right/upper middle abdomen, no rebound tenderness; low skin temperature and pale skin below the right knee, gangrene on the sole of the right foot, obvious tenderness on touch, exudate present but no significant foul odor; lower limb arteries: bilateral femoral arteries palpable, left popliteal artery ++ right -, left posterior tibial artery ++ right -, dorsalis pedis arteries bilaterally -; decreased muscle strength and superficial/deep sensation in the right toes.

ABI：Right 0.46; Left 0.59.

Rutherford Classification:Level 6.

Preoperative

Proposed Surgical Strategy:Debulking (Shockwave Balloon) + DCB.

The patient was in the supine position, routinely disinfected and draped. Under ultrasound guidance in the left inguinal region, a retrograde puncture of the left femoral artery was successfully performed, and a 5F vascular sheath was inserted. Under DSA, a guidewire + catheter was advanced to the bifurcation of the abdominal aorta for angiography: multiple calcified plaques were visualized in both common iliac arteries, and blood flow in both iliac arteries was unobstructed.

The C2 catheter was advanced across to the right deep femoral artery, and a super-stiff guidewire was left in place. A 7F 55cm long sheath was then positioned in the common femoral artery. Angiography through the sheath revealed extensive calcification throughout the superficial femoral artery, with an approximately 5cm occlusion in the mid F2 segment, and mild-to-severe stenosis in the remaining lumen. Delayed imaging showed collateral circulation from the deep femoral artery to the popliteal artery and infrapopliteal arteries. Severe calcification and stenosis were observed in the P1 segment of the popliteal artery. The rest of the popliteal artery and the tibioperoneal trunk demonstrated patent blood flow. The anterior tibial artery showed good contrast filling, moderate stenosis in part of the posterior tibial artery with slightly sluggish flow, and the peroneal artery filled well with patent vessels below the ankle.

VR catheter + CXI catheter + guidewire successfully passed through the lesion segment in the antegrade direction, establishing an antegrade pathway. The guidewire was exchanged and placed in the proximal segment of the peroneal artery. A 4*120mm 0.14 balloon was used for pre-dilation of the lesion segment. Angiography showed significant improvement in blood flow with elastic recoil in multiple calcified segments.

InDEEPQUAKE Shock Wave BalloonThe 6*80mm segmental dilation P1 to the opening segment of the superficial femoral artery was performed using level 5 energy, with a total of 17 cycles and 510 shocks, completing the treatment of the entire lesion segment. No contrast agent leakage was observed upon reexamination.

A short segment dissection was formed in the distal segments of P1 and F1, without flow limitation. After exchanging for an ultra-hard guidewire, sequential dilation was performed on the entire segment from P1 to the superficial femoral opening using a 5*220mm drug-coated balloon and a 6*150mm drug-coated balloon, lasting for 3 minutes. Repeated angiography showed significant improvement in blood flow, with partial healing of the P1 segment dissection. Follow-up angiography revealed smooth blood flow throughout the superficial femoral artery, good visibility of the infrapopliteal branches, palpable dorsalis pedis artery pulse, and no change in the iliac artery.

Withdraw the catheter sheath, suture the puncture site with a suture, apply local pressure for several minutes, and then apply pressure dressing.