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Objectives: Whether or not using the gastroepiploic artery (GEA) is associated with improved outcomes of coronary artery bypass grafting (CABG) remains unclear. Previous research has shown that the short-term function of the GEA was strongly associated with the degree of native vessel stenosis. We assessed the association between long-term GEA patency and the degree of stenosis of the coronary artery.
Methods: We retrospectively examined 517 patients who underwent CABG with an in situ semiskeletonized GEA from January 2000 to January 2015. In this cohort, 282 (54.5%) patients underwent distant radiological evaluations for >1 year post-surgery (range 1-18 years after surgery). Quantitative coronary angiography was used to measure the degree of stenosis of the native coronary artery. Preoperative angiographic parameters include the minimal lumen diameter (MLD) and the percentage of target vessel stenosis. A multivariable stepwise Cox proportional hazards regression analysis was used to identify predictors of angiographic occlusion.
Results: The cumulative patency rate of the GEA was 79.3% at 10 years. A multivariable analysis showed that an MLD (hazard ratio 4.43, 95% confidence interval 3.25-6.82; P < 0.001) was an independent risk factor of GEA occlusion. A time-dependent receiver operating characteristic (ROC) curve analysis identified that an MLD >1 mm was set as the cut-off value for graft occlusion. Patients with an MLD <1 mm had a 10-year patency rate of 89.8%.
Conclusions: The long-term patency of the semiskeletonized GEA was acceptable. The target vessel MLD obtained using quantitative coronary angiography was a strong predictor of patency. Good long-term patency can be expected for an MLD <1 mm.
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http://dx.doi.org/10.1093/icvts/ivy346 | DOI Listing |
JTCVS Tech
December 2024
Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.
Objective: To evaluate the clinical outcomes of right gastroepiploic artery use in minimally invasive coronary artery bypass grafting.
Methods: A total of 428 patients who underwent minimally invasive coronary artery bypass grafting from February 2012 to February 2024 were included into this retrospective cohort study. The selection criteria for right gastroepiploic artery use included satisfactory artery size and length, significant stenosis (99% to 100%) of the right coronary artery, and unsuitable ascending aorta for partial clamping.
Surg Technol Int
December 2024
Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan.
Introduction: Pancreaticoduodenectomy after proximal gastrectomy (PG) presents technical challenges owing to the need to preserve blood flow in the remnant stomach. Considering the oncological factors and preservation of the remnant stomach blood supply, it is crucial to preserve or reconstruct the right gastric artery (RGA) and/or right gastroepiploic artery (RGEA). In cases where the RGEA is preserved, technical considerations for reconstruction arise owing to the poor motility of the remnant stomach.
View Article and Find Full Text PDFKyobu Geka
September 2024
Department of Cardiovascular Surgery, Gifu University, Gifu, Japan.
In Japan, the vascular grafts employed in coronary artery bypass surgery comprised 69% internal thoracic artery, 35% great saphenous vein, 3% right gastroepiploic artery, and 3% radial artery. Graft harvesting for coronary artery bypass grafting is deemed the foundational skill to be mastered in cardiovascular surgery training and is frequently executed by novice surgeons. However, while redoing the anastomosis is relatively straightforward, repairing a damaged graft is exceedingly challenging.
View Article and Find Full Text PDFSurg Case Rep
November 2024
Department of Surgery, Toyota Kosei Hospital, 500-1 Josui-cho, Toyota, Aichi, 470-0396, Japan.
Background: Blood supply to the remnant stomach should be preserved during pancreatectomy in patients with a history of gastrectomy. Moreover, ischemic complications should be considered when performing pancreatoduodenectomy in patients with celiac axis and superior mesenteric artery (SMA) stenosis. However, whether these surgical procedures can be safely performed remains unclear.
View Article and Find Full Text PDFCureus
October 2024
Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN.
Spontaneous non-aneurysmal gastroepiploic arterial hemorrhage is a rare occurrence, and its association with celiac axis compression syndrome (CACS), also referred to as median arcuate ligament syndrome (MALS), is even more uncommon. Furthermore, nontraumatic intraperitoneal hemorrhage due to defecation strain is also rare. This study reports an extremely rare case of non-aneurysmal gastroepiploic arterial hemorrhage with CACS/MALS after defecation strain.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!