BackTable Vascular & Interventional Ep. 615 Exploring Intravascular Lithotripsy in Below the Knee CLTI with Dr. Constantino Peña
Feb 10, 2026
Dr. Constantino Peña, a vascular and interventional specialist focused on tibial and below‑the‑knee limb salvage, walks through modern strategies for treating heavily calcified tibial arteries. He discusses intravascular lithotripsy, device deliverability, sizing and technique. Short, practical takes cover combining IVL with adjuncts, workflow decisions, and what next‑gen tools clinicians want.
AI Snips
Chapters
Transcript
Episode notes
E8 Iteration Expanded Tibial IVL Use
- New generation IVL balloons (E8) improved deliverability and pulse capacity for tibial use.
- One E8 balloon can often treat one or two tibials thanks to higher treatment counts.
Size IVL Balloons One-To-One And Start Low
- Size IVL balloons roughly 1:1 to vessel diameter and start treatment at ≈2 atm to visualize balloon contour.
- Increase pressure toward nominal (≈4 atm) for final treatments and use IVUS for accurate sizing when possible.
Move The Balloon To Create Overlap
- Move and slightly overlap the IVL balloon emitters during treatment to ensure even coverage.
- Deflate and reposition to avoid treating only one zone and to maximize pulse distribution.