Computed tomographic angiography to evaluate the right gastroepiploic artery for coronary artery bypass grafting

The right gastroepiploic artery (RGEA) is widely used as an in situ arterial graft for coronary artery bypass grafting (CABG); however, it is impossible to measure an RGEA or check for calcification or stenosis and assess its suitability as a graft before angiography or harvest. We evaluated the accuracy of preoperative three-dimensional computed tomographic angiography (3D-CTA) for assessing the suitability of RGEAs for CABG.

We used 4-channel multidetector-row computed tomography with intravenous contrast medium. All the RGEAs had an intraluminar diameter greater than 1.5 mm. RGEAs longer than two-thirds of the greater curvature of stomach, longer than half of the greater curvature, and shorter than half of the greater curvature were defined as large, moderate, and small, respectively.

Of the 36 patients examined, 5 (14%) had a small RGEA, 16 (44%) had a moderate RGEA, and 15 (42%) had a large RGEA. We confirmed intraoperatively that two small RGEAs were unsuitable for grafting because they could not reach the posterior descending artery (PDA). The other three small RGEAs were not used. Two of the large and moderate RGEAs with diffuse narrowing and severe calcification were also unsuitable for grafting. This eliminated the need for a laparotomy to harvest the RGEA in five (14%) patients. Intraoperative findings confirmed that all the moderate RGEAs could be anastomosed to the PDA. All the large RGEAs reached the posterolateral artery (PLA), and more than half reached the PLA branching circumflex artery.

Preoperative noninvasive evaluation by 3D-CT is effective for assessing the suitability of RGEAs for CABG.