Shockwave Lithotripsy: Arterial Aneurysms and Vascular Complications

Abstract

There is currently no high-level evidence to suggest that SWL in the presence of arterial aneurysm is unsafe. Experimental work on ex vivo human tissue does not suggest that SWL is causative to aneurysm rupture. With the availability of CT imaging in modern clinical practice, aneurysms of the arterial tree should be identified as part of the investigation of urinary tract calculi. SWL can be safely performed in patients with AAA, but monitoring postprocedure is mandatory, along with access to emergency vascular surgery support; importantly, any onset of new pain or symptoms should be aggressively investigated by radiologic imaging in the first instance.

Indications and contraindications for shock wave lithotripsy and how to improve outcomes

“…Aortic aneurysms pose a bleeding risk for patients undergoing SWL and classically, are included in the list of contraindications. The literature, however, is mixed on the safety of SWL in patients with aneurysms, with some case reports outlining complications, while other documents safe treatment [8] , [9] .…”

Pseudoaneurysm of external iliac artery after extracorporeal shock wave lithotripsy revealing Behçet disease

“…3 Complications arising within the arterial tree but outside the aorta are rare and are limited to several single case reports. 1 In our case, data showing the causal relationship of ESWL with arterial wall disease were relatively clear: the onset of abdominal and right inguinal pain immediately after the last ESWL session; the CT imaging, which identified a pseudoaneurysm in the same region occupied by previous ureteral calculi; the location of the patient's treated calculus within the parallel axis of shock waves not far from the region of the pseudoaneurysm ( Fig 2); and the patient's history of hypertension, with some calcifications on CT, which could represent a pseudoaneurysm from rupture of a calcified plaque. However, the patient was 35 years old, and we believe that the inflammatory hypothesis is most probable.…”

“… 3 Complications arising within the arterial tree but outside the aorta are rare and are limited to several single case reports. 1 …”

“…Extracorporeal shock wave lithotripsy (ESWL) has been widely used to treat upper urinary tract calculi, although severe complications may be encountered. 1 We report the case of a 35-year-old man who presented with a pseudoaneurysm of the external iliac artery revealing Behçet disease 1 month after the last ESWL session for treatment of ureteral calculi. The causal relationship of ESWL with arterial pseudoaneurysm formation in a patient with Behçet disease is discussed.…”

Endovascular treatment of abdominal aortic rupture after percutaneous lithotripsy

“…In cases of hemodynamic instability, the patient must first be stabilized, and, when possible, should undergo computed tomography (CT) angiography of the abdomen, which is the imaging modality of choice for the diagnosis and planning of endovascular treatment. Rupture of an AAA is more likely to occur in the retroperitoneal space than in the peritoneal cavity, mortality rates being higher if it occurs in the latter (4) .…”