Right Gastroepiploic Artery Graft for Myocardial Revascularization: Prevalence of Atherosclerosis and Availability as a Conduit

Cho, Kwang Ree; Hwang, Ho Young; Kim, Jun Sung; Kim, Ki-Bong

doi:10.1016/j.athoracsur.2010.10.001

Cited by 11 publications

(5 citation statements)

References 18 publications

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“…65 years), insulin-dependent diabetes mellitus, and chronic renal failure as independent predictors of atherosclerosis. 11 In our series, no RGEA was discarded due to atherosclerosis or low blood flow. On the other hand, SVG was used because of its accessibility, sufficient length, and ease of use despite its lower patency rate compared with that of arterial grafts.…”

Section: Discussionmentioning

confidence: 99%

Graft Selection for the Right Coronary Artery Territory in Off-Pump Coronary Artery Bypass

Jeong

Lee

Min

et al. 2012

Thorac cardiovasc Surg

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Section: Discussionmentioning

confidence: 99%

Graft Selection for the Right Coronary Artery Territory in Off-Pump Coronary Artery Bypass

Jeong

Lee

Min

et al. 2012

Thorac cardiovasc Surg

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“…The right gastroepiploic artery with a mean diameter of 2.7 mm 28 is clearly suitable for microvascular anastomosis, although insufficient caliber or length prevents its use in 5 to 6% of coronary artery bypass grafting procedures. 29,30 The latter would also apply to microsurgical sternal reconstructions. Therefore, preoperative assessment of recipient vessel suitability by computed tomography angiography should be considered.…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous Loop–Independent Free Flap Reconstruction of Sternal Defects after Cardiac Surgery

Dornseifer

Kleeberger

Ehrl

et al. 2016

J reconstr Microsurg

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Background Sternal defects following deep wound infections are predominantly reconstructed using local and regional flaps. The lack of appropriate recipient vessels after cardiac surgery may explain the minor role of free flaps. To date, arteriovenous loops have been the leading solution to enable microsurgical closure of these defects. However, the related surgical effort and the risk of flap failure are increased. We reviewed our experiences with the right gastroepiploic vessels as alternative recipient vessels for free flap reconstructions. Methods Between September 2010 and July 2015, 12 patients suffering deep wound infection after cardiac surgery underwent sternal reconstruction with free flaps anastomosed to the right gastroepiploic vessels. Gracilis flaps (n = 8) and anterolateral thigh perforator flaps (n = 4) were used for sternal reconstruction. Recipient vessels were harvested by laparoscopic dissection in five patients. Half of the free flaps were variably combined with omental flow-through flaps. Results Healing of all flaps was uneventful with no partial or total flap loss. Simultaneous interdisciplinary harvesting of recipient vessels by laparoscopy significantly shortened mean operative time from 313 to 216 minutes (p = 0.018). One incisional hernia was observed in the laparotomy group. Revision of a gracilis donor site was necessary in another patient due to postoperative bleeding. No recurrent sternal infection occurred during a mean follow-up of 20 months (range, 3-59 months). Conclusions The concept of gastroepiploic recipient vessels allows reliable free flap reconstructions of sternal defects in such high-risk patients without the need for arteriovenous loops.

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“…29 It has been reported that 12.3% of patients with ischemic heart disease have stenosis of the right gastroepiploic artery due to arteriosclerosis. 30 Patients with cerebrovascular disease or dyslipidemia are also known to have a high risk of cardiovascular disease. 31,32 Accordingly, it is necessary to pay careful attention to the presence of arteriosclerosisrelated disease before surgery.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Blood Flow at the Tip of the Reconstructed Gastric Tube During Esophagectomy: A Study Using Indocyanine Green Fluorescence Angiography

Kumagai

Ishiguro

Sobajima

et al. 2016

International Surgery

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The objective of this study was to clarify the factors affecting blood flow at the tip of the gastric tube during esophagectomy using indocyanine green (ICG) fluorescence angiography. The time until enhancement of the gastric tube tip determined using ICG fluorescence imaging is a useful indicator of blood flow, and has been shown not to differ significantly according to the connection status of the right or left gastroepiploic artery. Using ICG fluorescence imaging, the time until enhancement of the gastric tube tip was measured in 50 patients undergoing esophagectomy. Blood flow at the gastric tube tip was compared between 2 groups of patients: those in whom a connecting vessel from the left gastro-epiploic artery to the short gastric artery (l-s GA) was present and those in whom it was absent. The factors affecting blood flow to the gastric tube tip were also investigated using univariate and multivariate logistic regression analysis. The median time taken for the gastric tube tip to show enhancement with ICG was significantly shorter in the group with an l-s GA connection (P ¼ 0.02). Multivariate analysis showed that the absence of an l-s GA connection (P ¼ 0.04) and presence of arteriosclerosis-related disease (P ¼ 0.02) were significant independent factors that delayed blood flow to the gastric tube. It is essential to preserve the whole vessel arcade of the greater curvature to achieve good perfusion of the gastric tube with blood. The

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Right Gastroepiploic Artery Graft for Myocardial Revascularization: Prevalence of Atherosclerosis and Availability as a Conduit

Cited by 11 publications

References 18 publications

Graft Selection for the Right Coronary Artery Territory in Off-Pump Coronary Artery Bypass

Graft Selection for the Right Coronary Artery Territory in Off-Pump Coronary Artery Bypass

Arteriovenous Loop–Independent Free Flap Reconstruction of Sternal Defects after Cardiac Surgery

Factors Affecting Blood Flow at the Tip of the Reconstructed Gastric Tube During Esophagectomy: A Study Using Indocyanine Green Fluorescence Angiography

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