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First time in India-Intra Vascular Lithotripsy used to tackle calcified blockage in the Kidney artery



On 2nd October, a 66yr old male arrived at the Emergency Room at Fortis Hospital, Kalyan, with complains of breathlessness. Post thorough evaluation, the patient was shifted to the ICUunder the care of Dr Vivek Mahajan, Interventional Cardiologist. The patient’s blood pressure was elevated to alarming levels. With medication, there was some amount of success in bringing down the pressure and also reducing swelling in his Lungs. A 2D Echo was performed which showed that the Heart was healthy but it’s function was impaired because of high blood pressure; an Angiography showed minor blockages. Further investigation was done, including Kidney Angiography, which showed that there was a blockage in the Kidney artery. One side revealed 90% blockage and the other side was fairly clear; a chunk of Calcium was clearly seen in the Angiography.

An Angioplasty was advised for this blockage. Cracking this Calcium-dense blockage was necessary for successful expansion of the stent. Traditional plasty balloons would have failed at this task; and older technologies like diamond coated drills, high pressure balloons and cutting balloons, carry a risk of damage to the artery. A relatively new technology Intra Vascular Lithotripsy was chosen as the mode of intervention. This technique is well in use for Heart and the limb arteries; however, there is only one case report of use of this technique on the Kidney artery all over the world, and none from India. Here two electrodes within a balloon pass a current to create heat bubbles, these bubbles expanded & collapse back within a fraction of a second to create a shock wave effect which fractures the Calcium blockage into smaller

fragments. Thereafter stent expansion becomes easy, and the procedure can be completed with success.

 

Speaking about the success of this intervention, Dr Vivek Mahajan, Interventional Cardiologist, Fortis Hospital, Kalyan, said, “I extremely proud of my team for this achievement. Normally, when the Kidney arteries get blocked, blood flow to the Kidneys is compromised and their function is impacted. This triggers a hormonal release that shoots up the blood pressure, putting excessive stress on the Heart. Lungs also swell-up as the functioning of the Heart is impaired. In this case, traditional technique of Angioplasty would have not given us 100% result, and hence we opted for the Intra Vascular

Lithotripsy technique. This procedure has never been done in the country before, we are happy to be the 1st to use it successfully, and happy with the patient’s recovery”.

 

Patient Mr. Bharat Wagh, said, “On 2nd when I started experiencing discomfort and pain in my chest, my wife rushed me to Fortis Hospital, Kalyan where the procedure was performed. I was happy to be able to see myself walk back home. Many thanks to the doctors and nurses, who treated me like their family”.Dr. Vivek Mahajan further added, “Post-intervention, the patient recuperated well in the ICU and was discharged on October 19th 2020. His BP was 120 (systolic) during discharge, as against 160 (systolic) before the intervention”.

Source - Medgatetoday Magazine

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