Gujarat's First IVL-Guided Angioplasty to Renal Artery Done at City's Bhailal Amin General Hospital

The Clinical Team has achieved a stupendous success by applying a uniquely advanced technique in the case of an 80-year-old lady (Vadodra native) suffering from breathlessness & uncontrolled hypertension. She was admitted to the city's Bhailal Amin General Hospital for her treatment on the same grounds.

Doctors immediately started the treatment, and the patient was made stable. However, her renal function deteriorated after a few days. She stopped passing the urine, and excess fluid was trapped in her lung tissues.

Dr Killol Kaneria, Primary Consultant Cardiologist at Bhailal Amin General Hospital, examined the case and decided to do an unusual Intravascular Lithotripsy (IVL)-guided angioplasty to her left renal artery.

Conventionally, this therapy is used for Coronary Artery Calcification (CAC) for major cardiovascular events. The IVL utilises a one-time disposable monorail catheter with an internally mounted ultrasound core positioned around a guidewire. A balloon surrounds the central apparatus; this is a piece of inflatable equipment.

Also, the IVL system incorporates a portable regenerator to provide energy to supply two sets of radiopaque and traditional emitters, which are within the central and lateral boundaries of the balloon; these transmitters produce intermittent sonic pressure waves resulting in the delivery of mechanical energy to the target lesion.

The acoustic energy results in the creation of micro-cracks within the calcified plaque with each transmission. The consecutive impulses cause an increase in vessel compliance with preservation of underlying wall composition, allowing complete balloon opening at substantially reduced atmospheric pressures compared to more conventional techniques.

In this case, which involved the arteries going from the aorta (main artery originating from the heart) to the kidneys, this technique was necessitated as both her left and right arteries had more than 80% blockages. In addition, severe calcification in the left artery was spotted too.

Calcific artery creates a unique challenge for percutaneous intervention as it will not permit adequate balloon and stent expansion. Calcific artery diseases are more prevalent in the old-age population. This calcific artery must be handled delicately to prevent complications during the procedure. It is one of those therapies that help achieve good results in the calcific artery.

With the full support of BAGH's management team, Dr Kaneria performed IVL-guided angioplasty on her left artery, and a stent was placed to avoid its narrowing in future. The procedure was done to dissolve the hard calcium deposits; otherwise, the solid substance would not allow the balloon to expand. Angioplasty to the right renal artery was done as a routine procedure.

The patient responded very well to the procedure, and her urine started passing with better renal function. No dialysis was required after the process, and other complications were resolved after the treatment. As a result, the patient's condition drastically improved, and her recovery accelerated.

It is a matter of great pride for the city of Vadodara, especially for the Bhailal Amin General Hospital, to become the first to perform IVL-guided renal angioplasty in Gujarat. This shall add to the availability of more comprehensive and advanced facilities in Vadodara.

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