Coronary Artery Bypass Grafting Using the Gastroepiploic Artery

Coronary artery bypass grafting (CABG) has been the mainstay treatment for coronary artery disease for several decades. Various conduit options have been attempted and studied to find the best vessel to optimize surgical outcomes. The literature describes multiple conduit options with particular benefits and complication rates. The saphenous vein graft, for example, is well documented in the literature as prone to atherosclerotic changes and is inferior in long-term patency rates compared to internal mammary artery grafts. The gastroepiploic artery (GEA) graft is another conduit option described in the late 1960s in the Vineberg procedure performed by Bailey et al where intramyocardial revascularization was done using the right GEA.  Sterling Edwards et al in the late 1970s attempted a direct anastomosis of the GEA to the right coronary artery. Since then, the GEA graft has been used as an alternative graft in several other documented landmark procedures. However, Pym in Canada and Suma in Japan are credited with popularizing the GEA as a viable coronary bypass conduit. These cases depict the various CABG anastomosis techniques that can be performed using the GEA. A CABG using a GEA conduit has the benefit of long-term patency and has been shown to provide optimal postoperative quality of life. This course will discuss the anatomy of the GEA, indications for CABG with GEA, contraindications, the surgical technique, possible complications, and clinical significance.