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

摘要

Patients CharacteristicsPreoperative Evaluation of the Right Gastroepiploic ArteryHarvesting of the Right Gastroepiploic Artery GraftStatistical AnalysisResultsAvailability of the Right Gastroepiploic Artery GraftRisk Factors for the Atherosclerotic Right Gastroepiploic Artery GraftWe evaluated prevalence of atherosclerosis and availability of right gastroepiploic artery graft in patients undergoing coronary artery bypass graft surgery.MethodsAmong the 1,579 patients who underwent isolated coronary artery bypass grafting between January 1999 and December 2008, we opened the peritoneum to examine the right gastroepiploic artery for use as a graft in 1,128 patients (71.4%). A computer-based patient database system was utilized for this retrospective study.ResultsOf 1,128 patients, 139 patients (12.3%) had atherosclerotic right gastroepiploic arteries at gross examination. Seventy-three of 139 atherosclerotic right gastroepiploic arteries had multiple or diffuse atherosclerotic lesions that precluded their use as a bypass graft; the remaining 66 right gastroepiploic arteries were used as a bypass graft including the atheromatous segment or after exclusion of the atherosclerotic segment. Another 60 nonatherosclerotic right gastroepiploic arteries were unavailable to use as a graft because of their short length, small caliber, and weak pulsation. Overall availability of the right gastroepiploic arteries as a graft was 88.2% (995 of 1,128). Multivariable logistic regression analysis showed older age (≥65 years; p < 0.001), insulin-treated diabetes mellitus (p = 0.001), and chronic renal failure (p < 0.001) as independent risk factors for atherosclerosis.ConclusionsThe prevalence of atherosclerosis and availability of the right gastroepiploic artery graft in patients undergoing isolated coronary artery bypass grafting was 12.3% and 88.2%, respectively. Older age (≥65 years), insulin-treated diabetes mellitus, and chronic renal failure were identified as independent predictors for the atherosclerotic right gastroepiploic artery.CTSNet classification:23Superior long-term patency of internal thoracic artery (ITA) grafts compared with saphenous vein grafts has expanded the use of arterial grafts, such as the radial artery and right gastroepiploic artery (RGEA), for myocardial revascularization [