Management of Right Gastroepiploic Arterial Coronary Grafts in Subsequent Abdominal Surgeries

Sakai, Kenji; Mizuno, Tomohiro; Watanabe, Taiju; Nagaoka, Eiki; Oi, Keiji; Yashima, Masafumi; Hachimaru, Tsuyoshi; Kuroki, Hidehito; Fujiwara, Tatsuki; Takeshita, Masashi; Tanabe, Minoru; Arai, Hirokuni

doi:10.1016/j.athoracsur.2018.01.078

Cited by 11 publications

(6 citation statements)

References 14 publications

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“…In other words, considering the resectability of the tumor during PD, GDA and RGEA must be preserved or reconstructed. There are 13 articles (including 5 Japanese articles) [26][27][28][29][30][31][32][33][34][35][36][37][38] that discuss PD after CABG using RGEA (Table 2). There were 16 patients in total including our case, and one of them was female, with a mean age of 70 years.…”

Section: Discussionmentioning

confidence: 99%

“…However, a CABG using RGEA in a patient with rare anatomical aberrant GDA should not be considered as an obstacle when R0 resection is achievable. 2019 Homsy et al [26] 73 M Pancreatic cancer PD Yes Intraoperative rerouting to GDA None None 2018 CreTu et al [22] 70 [23] 73 M Ampullary cancer PPPD No None Pseudoaneurysm of RGEA None 2015 Ito et al [24] 63 M Bile duct cancer PD No Preoperative PCI to RCA None None 2014 Kitamura et al [25] 67 M Bile duct cancer SSPPD No None None None 2014 Fukuhara et al [26] 66 F Ampullary cancer PPPD No None None None 2014 Fujikawa et al [27] 64 M Pancreatic cancer SSPPD Yes Preoperative PCI to RCA None None 2013 Turcanu et al [28] 71 M Pancreatic cancer PD No None None None 2011 Takami et al [29] 80 M Bile duct cancer SSPPD No None None None 2011 Nakamura et al [30] 69 M Ampullary cancer PD Yes Intraoperative rerouting (graft unspecified)…”

Section: Discussionmentioning

confidence: 99%

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Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting

et al. 2021

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Rationale: Pancreaticoduodenectomy (PD) is a technically demanding procedure with high rates of morbidity and mortality. Therefore, preoperative evaluation of anatomy is indispensable. Multi-detector row computed tomography (CT) enables us to precisely understand arterial anatomy. It is a well-known fact that anatomical variants are often present in the hepatic artery (HA) but rarely in the gastroduodenal artery (GDA). We present the case of a patient with ampullary cancer with a rare anatomical anomaly, “replaced GDA (rGDA) ” arising from the superior mesenteric artery, along with a history of coronary artery bypass grafting (CABG) using right gastroepiploic artery (RGEA). Patient concerns: A 69-year-old male patient was referred to our department for further investigation of elevated hepatobiliary enzymes. He presented with no symptoms besides intermittent fever of 38°C. He had an operative history of CABG using the RGEA. Diagnosis: Abdominal CT and esophagogastroduodenoscopy showed an ampullary tumor and biopsy specimen from the lesion revealed adenocarcinoma. CT angiography revealed the rGDA instead of a normal common HA. Intervention: We performed a safe PD, preserving the rGDA and the RGEA to maintain hepatic and cardiac perfusion. Outcomes: Owing to the presence of a refractory pancreatic fistula, the length-of-hospital stay was extended, and he was discharged on postoperative day 72 without vascular complications. At present, the patient is in good physical condition and does not present with cardiovascular complications as well as tumor recurrence at 6 months after surgery. Lessons: This is possibly the first case of a patient who underwent PD and has a proper HA following a GDA arising from a superior mesenteric artery (rGDA) and has a previous operative history of CABG using the gastroepiploic artery. The coexistence of the history of cardiovascular surgery made PD for this patient considerably more challenging. In the case of a rare anatomical anomaly, a coronary artery bypass via the RGEA should not be considered as an obstacle when R0 resection is achievable.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting

et al. 2021

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“…However, this involves entering the abdomen, which can lead to postoperative ileus, and may become an issue for patients who develop malignancies and require gastric or pancreatic resections. 21,22 In patients with >80 stenoses, the radial artery may be a better arterial conduit.…”

Section: Degree Of Distal Target Stenosismentioning

confidence: 99%

Commentary: Total arterial revascularization: Is it for everyone?

Lazar

2019

The Journal of Thoracic and Cardiovascular Surgery

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“…The right gastroepiploic artery (RGEA) can be used for severely stenotic right coronary arteries in coronary artery bypass grafting (CABG), and several reports have suggested good long‐term results with RGEA 1,2 . However, harvesting the RGEA requires complicated open surgery, which can cause severe intra‐abdominal adhesions 3 . Reports of gastric cancer after CABG using RGEA have increased 4,5 .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 However, harvesting the RGEA requires complicated open surgery, which can cause severe intra-abdominal adhesions. 3 Reports of gastric cancer after CABG using RGEA have increased. 4,5 Spasm and injuries of the graft during subsequent gastrectomy can cause critical coronary failure.…”

Section: Introductionmentioning

confidence: 99%

Real‐time vessel navigation using indocyanine green fluorescence during robotic‐assisted gastrectomy for gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery

Kamada

Ohdaira

Nakashima

et al. 2023

Asian J Endoscop Surgery

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Injury to the right gastroepiploic artery (RGEA) graft during gastrectomy after coronary artery bypass grafting (CABG) can cause critical coronary failure. A man in his 60s with advanced gastric cancer and a history of CABG was admitted to our hospital. His cardiac blood flow was dependent on RGEA, and a gastrectomy with RGEA preservation was necessary. Robot-assisted distal gastrectomy with real-time vessel navigation using indocyanine green (ICG) fluorescence imaging and Da Vinci Firefly technology was planned. Intraperitoneal observation revealed severe adhesions around the graft. Two milliliters ICG (2.5 mg/mL) was injected intravenously, and RGEA was visualized. An RGEA-preserving robot-assisted distal gastrectomy was successfully performed. The operation time was 279 minutes, and the blood loss was 5 mL. The postoperative course was good and there were no complications.

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Management of Right Gastroepiploic Arterial Coronary Grafts in Subsequent Abdominal Surgeries

Cited by 11 publications

References 14 publications

Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting

Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting

Commentary: Total arterial revascularization: Is it for everyone?

Real‐time vessel navigation using indocyanine green fluorescence during robotic‐assisted gastrectomy for gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery

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