Management of Right Gastroepiploic Arterial Coronary Grafts in Subsequent Abdominal Surgeries
Autor: | Masashi Takeshita, Masafumi Yashima, Eiki Nagaoka, Keiji Oi, Hirokuni Arai, Tsuyoshi Hachimaru, Taiju Watanabe, Minoru Tanabe, Hidehito Kuroki, Tatsuki Fujiwara, Kenji Sakai, Tomohiro Mizuno |
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Rok vydání: | 2017 |
Předmět: |
Pulmonary and Respiratory Medicine
Male Reoperation medicine.medical_specialty Time Factors medicine.medical_treatment Coronary Artery Disease 030204 cardiovascular system & hematology Right gastroepiploic artery Risk Assessment Pancreaticoduodenectomy Cohort Studies 03 medical and health sciences 0302 clinical medicine In Situ Arterial Graft Laparotomy medicine.artery medicine Humans Saphenous Vein Coronary Artery Bypass Digestive System Surgical Procedures Aged Retrospective Studies business.industry Anastomosis Surgical Graft Survival Middle Aged medicine.disease Surgery Survival Rate surgical procedures operative medicine.anatomical_structure Treatment Outcome 030228 respiratory system Right coronary artery Cholecystitis Abdomen Female Patient Safety Cardiology and Cardiovascular Medicine business Gastroepiploic Artery Abdominal surgery Follow-Up Studies |
Zdroj: | The Annals of thoracic surgery. 106(1) |
ISSN: | 1552-6259 |
Popis: | Background The right gastroepiploic artery (GEA) is utilized as an excellent in situ arterial graft conduit to right coronary artery territory for coronary artery bypass grafting (CABG). However, there remain great concerns regarding the management of patients with a patent in situ GEA during abdominal surgery following CABG. Methods From 1995 to 2016, GEA was used for CABG in 278 patients at our institution. Of the patients, 14 abdominal surgeries were performed for subsequent abdominal diseases in 11 patients with a patent in situ GEA for CABG. We investigated the results of the surgeries and how to manage the GEAs in abdominal surgery. Results Laparotomy was required for gastric cancer in 3 patients, pancreatic cancer in 3, hepatic cancer in 2, cholangiocarcinoma in 1, duodenal papillary head cancer in 1, and cholecystitis in 1; multiple abdominal surgeries were needed in 2 patients for cancer recurrence and ileus. The intraabdominal adhesions around the GEAs were minimal in all patients. No graft injury occurred at the time of opening of the abdomen, and the planned procedures were completed without any circulatory problems. In 3 patients undergoing pancreaticoduodenectomy, intraabdominal off-pump rerouting of the GEA with a short saphenous vein was necessary for en bloc resection of the cancers and lymph nodes. There was neither operative mortality nor graft-related cardiac event except for 1 due to multiple organ failure. Conclusions Although intraabdominal rerouting of GEA is necessary for pancreaticoduodenectomy, abdominal surgery can be safely performed in patients with a patent in situ GEA coronary graft. |
Databáze: | OpenAIRE |
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