Thoracic endovascular aortic repair (TEVAR) is the preferred treatment for ruptured thoracic aortic aneurysms. Poor access vessels are a relative contraindication to TEVAR. Intravascular lithotripsy (IVL) has recently been shown to be effective in treating calcified and stenotic vessels. Prior to the introduction of IVL, plaque modification techniques to increase vessel compliance and luminal diameter were limited to technically complex and risky surgical and interventional radiologic procedures. We present a case demonstrating the use of IVL in the emergency setting to treat severe atherosclerotic stenoses in the abdominal aorta and the iliac artery to facilitate TEVAR of a ruptured thoracic aortic aneurysm.

Interventional radiology plays an integral role in the management of massive and recurrent submassive hemoptysis. Risks of bronchial artery embolization (BAE) are well described and include spinal ischemia and paralysis, most often related to nontarget embolization of the artery of Adamkiewicz or other large radiculomedullary artery supplying the anterior spinal artery. There is increasing literature regarding spinal infarction following BAE when arterial supply to the spinal cord was not evident. The existence of unrecognized patient comorbidities may further contribute to procedural risks.