Background Our objective is to present the Peripheral Intravascular Lithotripsy (IVL) System in the treatment of calcific renal artery stenosis (RAS) during Chimney Endovascular Aneurysm Repair (Ch-EVAR). The Ch-EVAR technique is a bail out procedure in treating aortic aneurysms with challenging anatomy regarding the proximal sealing zone. RAS typically involves varying degrees of calcification, and final treatment can be fraught with risk of vessel’s damages and suboptimal results, particularly when renal angioplasty represents the only feasible course of action in Ch-EVAR. Method We present a case of a patient with a complex juxtarenal abdominal aortic aneurysm and a pre-obstructive chalky stenosis of the right renal artery who underwent mono ChEVAR associated to visceral Intravascular Lithotripsy shockwave angioplasty. Conclusion IVL is an attractive modality for the treatment of challenging, heavily calcified renal arteries that combines the calcium-disrupting capability of lithotripsy with the familiarity of balloon catheters to facilitate proper stent deployment. Result We propose the IVL system as an additional tool in the vascular surgeon’s armamentarium not only to obtain large-bore access to enable Transaortic Valve Replacement (TAVR) and EVAR but also to perform angioplasty of severely calcified visceral arteries during Ch-EVAR.

Sciatic nerve varices (SNV) represent an infrequent presentation of varicose veins. They are usually not recognised and may present only with chronic sciatic pain with few varicosities. On clinical examination, sciatic pain can be reproduced by finger-pressing the superficial varicose veins at their point of connection with the SNV. These varices are then confirmed by duplex ultrasonography. We herein report a case of a 78-years-old woman affected by symptomatic SNV, treated by echo-guided Tessari foam sclerotherapy (EGFSCL) with immediate relief of the sciatic pain. Reflux through the sciatic veins, as the connected superficial varicose veins, disappeared completely and not any complications have emerged. EGFSCL seems to be both safe and effective, so representing a reliable and minimally invasive treatment for this disturb.