BackTable Vascular & Interventional Ep. 623 CLTI: Lithotripsy and Endovascular Techniques for Below the Knee Interventions with Dr. Paul Foley
6 snips
Mar 10, 2026 Dr. Paul Foley, a vascular surgeon focused on limb preservation and below-the-knee endovascular care, discusses treating heavily calcified tibial disease. He talks about evolving access strategies, intravascular lithotripsy (IVL) and the Disrupt BTK II trial, the Javelin catheter concept and technique, and how plaque-modifying tools are changing tibial workflows.
AI Snips
Chapters
Transcript
Episode notes
BTK Disease Is A Distinct High-Risk Problem
- Below-the-knee (BTK) calcified disease is often the sickest limb-threatening ischemia population with multi-level disease that requires staged, deliberate planning.
- Paul Foley recommends setting up ipsilateral antegrade or retrograde pedal access and using imaging to identify dense calcium before choosing plaque-modifying therapy.
Use IVUS Routinely To Guide BTK Therapy
- Use IVUS liberally below the knee to confirm calcium, gauge calcium density, and get accurate vessel sizing rather than relying on angiogram guesswork.
- Foley says IVUS guides device selection and balloon sizing which improves outcomes and reduces blind oversizing.
IVL Shows Strong Safety And Efficacy In BTK Trials
- Disrupt BTK II and prior IVL datasets show significant diameter stenosis reduction and excellent short-term safety in heavily calcified tibial lesions.
- The trial enrolled mostly CLTI patients and reported low angiographic complications and low tibial stent rates at 30 days and one year.