The Right Gastroepiploic Artery in Coronary Artery Bypass Grafting

Abstract

The right gastroepiploic artery (RGEA) has been used as a conduit in coronary artery bypass grafting. Although some reports presenting good results justify its use in clinical settings, there is still much concern about using the RGEA in bypass surgery. The RGEA demonstrates different behaviors from the internal thoracic artery (ITA) in bypass surgery due to its histological characteristics and anatomical difference, which might contribute to the long-term outcome. Now that left ITA (LITA) to left anterior descending artery (LAD) is the gold standard, other grafts are expected to cover the rest of the coronary arteries. It should be elucidated how we can use other grafts and what we can expect from them. RGEA, as an arterial graft, can be used as an in situ graft or a free graft. The RGEA is mainly used to graft to the right coronary artery (RCA) because of its anatomical position, and its patency is not inferior to that of the saphenous vein (SVG). The RGEA can cover the lateral walls when its length is long enough or by making a composite graft with other grafts. However, when used to graft to the LAD, its mid-term patency is not favorable.

Y grafting for coronary artery bypass: is it as good as single grafting?

“…Moreover, it has also been recently confirmed that the GEA can be used as a Y graft and then anastomosed to circumflex territory [21 ], albeit there are controversial reports about the patency rates: whereas Ryu et al [15] reported excellent results, Santos et al [22] described a poor patency rate of the LIMA-GEA grafts when compared with the LIMA-radial artery grafts. Therefore, as a Y graft, the GEA could be used in specific subsets of patients, such as diabetic, obese, with COPD (not suitable for bilateral IMA harvesting) or with renal insufficiency, positive Allen test, or radial artery calcifications.…”

“…Therefore, as a Y graft, the GEA could be used in specific subsets of patients, such as diabetic, obese, with COPD (not suitable for bilateral IMA harvesting) or with renal insufficiency, positive Allen test, or radial artery calcifications. It should be stressed that the use of the GEA is not feasible in patients with previous abdominal surgery and should be carefully elected in patients at potential risk for abdominal surgery [21 ].…”

Stem Cell Sources for Vascular Tissue Engineering and Regeneration

“…[2][3][4][5] Other autologous arterial/venous grafts, cryopreserved cadaveric grafts, umbilical vein grafts, and arterial allografts have also been tried but with limited success because of associated complications. [6][7][8][9][10][11] Although autologous vessels from patients remain the grafts of choice, in many cases, previous harvest, morbidity at the donor site, or disease progression limit the availability of native grafts. 12,13 Clinical studies suggest that only a limited number of patients undergoing CABG surgeries have suitable arterial grafts and up to 30% of patients requiring venous grafts for peripheral vascular diseases lack transplantable veins.…”

Availability of the right gastroepiploic artery for coronary artery bypass grafting: preoperative multidetector CT evaluation

“…Since the introduction of the right gastroepiploic artery (RGEA) as a graft in coronary artery bypass grafting (CABG) by Pym [1] and Suma [2] in 1987, it has been widely used as a graft in coronary artery bypass grafting because it is ease to harvest and has a lower morbidity related to surgery [3]. The RGEA graft also has a high clinical availability for coronary artery bypass grafting [4], low incidence of arteriosclerosis [5], and sufficient flow capacity [6].…”