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Primary Open Stenting to Simplify Distal Anastomosis on Heavily Calcified Artery: The POSE Technique
Raphaël Coscas1, Pierre Maitrias1, Isabelle Javerliat1
1Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France; Université Paris-Saclay, Université Versailles Saint-Quentin en Yvelines, CESP, INSERM-U1018, Equipe 5, Villejuif, France.
Insights
The primary open stenting followed by localized endarterectomy (POSE) technique simplifies surgical repair of heavily calcified arteries (HCA). This novel approach aims to reduce complications associated with traditional methods for distal anastomosis in HCA.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Biomedical Engineering
Background:
- Distal anastomosis on heavily calcified arteries (HCA) presents significant surgical challenges.
- Traditional methods risk arterial dissection, thrombosis, and require extensive searching for suitable sites or advanced techniques like stent-grafts.
Purpose of the Study:
- To introduce and describe a novel technique, primary open stenting followed by localized endarterectomy (POSE), to simplify open surgical procedures on HCA.
- To provide an alternative method for securing distal anastomosis in HCA, potentially reducing surgical complications.
Main Methods:
- The POSE technique involves primary open stenting followed by localized endarterectomy.
- This method is designed for direct application during open surgical procedures on HCA.
Main Results:
- The POSE technique has been successfully applied in 24 patients to date.
- Initial outcomes suggest the technique simplifies the procedure for distal anastomosis on HCA.
Conclusions:
- The POSE technique offers a promising simplification for open surgical procedures on heavily calcified arteries.
- Further studies are required to determine the long-term durability and efficacy of the POSE technique.
Abstract:
Despite improvements in surgical techniques, performing distal anastomosis on a heavily calcified artery (HCA) remains technically challenging. Clamping lesions and arterial wall trauma while suturing can lead to immediate or delayed arterial dissection and thrombosis. These issues are generally overcome by performing an extensive search for supple arterial zones, using sutureless techniques with covered stent-grafts and/or stenting the anastomosis under fluoroscopic guidance after unclamping. We describe a technique intended to simplify open surgical procedures on HCA. It consists of primary open stenting followed by localized endarterectomy (namely, the primary open stenting followed by localized endarterectomy [POSE] technique) to secure a distal anastomosis on an HCA. So far, we have successfully used the POSE technique in 24 patients but the durability of the technique remains to be determined.
