Recanalization of a Severely Calcified Superior Mesenteric Artery in the Setting of Extensive Paravisceral Aortic Calcification Using Intravascular Lithotripsy: A Case Report and Focused Literature Review

Calcified atherosclerotic plaques are a well-recognized cause of chronic mesenteric ischemia (CMI). We present a case where intravascular lithotripsy (IVL) was successfully used to treat a severely calcified and stenotic superior mesenteric artery (SMA). A 72-year-old male with diffuse atherosclerotic disease presented with acute-on-chronic abdominal pain and weight loss. Computed tomography angiography (CTA) demonstrated extensive calcified aortic atherosclerotic disease extending to the major branches, particularly the SMA, causing severe stenosis. Plain old balloon angioplasty (POBA) followed by Shockwave™ IVL enabled the placement of a stent graft, resulting in successful recanalization. Following the procedure, the patient reported significant improvement in abdominal pain. IVL provides a safe and effective method for managing severely calcified mesenteric lesions, particularly when standard angioplasty alone is insufficient. This case contributes meaningfully to the limited body of evidence supporting SMA-IVL and underscores its value in complex paravisceral arterial disease.