Postoperative angiographic evaluation of gastroepiploic artery grafts: Technical considerations and short‐Term patency

Abstract

Follow-up angiography was performed in 37 patients with right gastroepiploic artery (GEA) grafts at 27 +/- 32 days postoperatively. By the femoral approach, a 5F cobra or twist catheter was advanced selectively into the gastroduodenal artery (GDA) over a plastic-coated guidewire. In 29 patients, the GDA was successfully catheterized, and the GEA grafts were clearly visualized by the injection of 3-7 ml of contrast medium. GDA catheterization was unsuccessful in 8 patients, but in 4 of them the grafts were well visualized when 15-20 ml of contrast was injected. In the other 4 patients, visualization of the GEA grafts was poor, but the distal portions were outlined by retrograde perfusion from the native right coronary arteries. A total of 34 GEA grafts were patent (92%), and the diameters of these grafts were adequate when compared with respective recipient coronary arteries (2.8 +/- 0.9 and 2.3 +/- 0.6 mm, respectively; P less than .05). No complications were noted except for transient vasospasm (3 patients) in the GEA, hepatic artery, or both, which was relieved by the intra-arterial injection of isosorbide dinitrate (2.5 mg). Thus, the over-the-wire technique allows simple and safe GDA catheterization, which is essential for obtaining good visualization of GEA grafts.

The benefit of 64-MDCT prior to invasive coronary angiography in symptomatic post-CABG patients

“…This however, is complicated by vessel anatomy, which requires a catheter to pass sharp curves to reach the ostium of the GDA. Both the femoral and the brachial approach have their limitations and with both approaches the GEA graft can not always be visualised with CAG [15,18]. In our study seven GEA grafts were unevaluable on CAG due to non-selective catheterization of the grafts.…”

“…GEA grafts are therefore widely used as a second or third graft conduit to the internal thoracic artery [15][16][17]. It is also known that selective catheterization of the gastroduodenal artery (GDA) is essential for a clear visualisation of GEA grafts [18]. This however, is complicated by vessel anatomy, which requires a catheter to pass sharp curves to reach the ostium of the GDA.…”

Anesthesia for pancreatoduodenectomy in a patient with history of coronary artery bypass graft surgery: determination of optimal surgical management by the graft clamping test

“…We believe that the clamping test is required in all patients except those whose RGEA graft is obviously occluded, as assessed by angiography or echocardiography. Selective RGEA angiography is not always easy; there is a 78% success rate with RGEA catheterization [4]. When the RGEA graft occlusion is confirmed by selective angiography or echocardiography, the clamping test can be omitted, and the RGEA graft can be ligated and cut without establishment of the interposition graft.…”

A 16-slice multidetector computed tomography protocol for evaluation of the gastroepiploic artery grafts in patients after coronary artery bypass surgery

“…Selective catheterisation of the gastroepiploic artery can be difficult, resulting in unsuccessful catheterisation of up to 22% [3].…”

“…Sometimes, follow-up includes evaluation of the graft with the reference standard, coronary angiography (CAG). However, selective catheterisation of the GEA graft is difficult and is unsuccessful in 22% of examinations [3]. Furthermore, CAG has significant morbidity and mortality [4,5].…”