Strategic Use of ENCLOSE-II Device for Proximal Anastomosis in a CKD Patient With Porcelain Aorta: Radiologic Insights and Surgical Outcomes

Abstract

This case report describes the innovative use of the ENCLOSE-II device for myocardial revascularization in a 65-year-old dialysis-dependent, hypertensive, triple vessel disease patient with extensive vascular calcification, including moderate grade of calcified ascending aorta according to Mills and Everson criteria, termed "porcelain aorta.”. Facing the challenge of an unclampable ascending aorta during coronary artery bypass grafting (CABG), we highlight the procedural adaptation and the role of ENCLOSE-II in facilitating successful proximal anastomosis without aortic clamping. Traditional no-touch and no-pump techniques, while reducing operative aggression, pose their challenges, including incomplete revascularization and recurrence of ischemia. Application of ENCLOSE II provided a good operative field and significantly minimized perioperative risks, showcasing a critical advancement in managing high-risk patients with predilection to increased rate and extent of vessel wall calcification, particularly aorta.