title: Skeletonization of gastroepiploic artery graft in off-pump coronary artery bypass grafting: early clinical and angiographic assessment.
abstract: BACKGROUND
  Recently skeletonization has been recognized as an alternative to pedicle harvesting of the internal thoracic artery as a technique that increases the length and caliber size of the graft compared with pedicled internal thoracic artery grafts; however, this is not yet popular for harvesting the gastroepiploic artery (GEA). We report here our experience of skeletonized GEA grafting in off-pump coronary artery bypass grafting with early clinical and angiographic results. The purpose of this study was to evaluate skeletonization of GEA grafting in off-pump coronary artery bypass grafting with a large patient volume.
  
  
  METHODS
  One hundred sixty-eight patients including 131 men and 37 women (mean age, 65 years; range, 45 to 87 years) underwent the skeletonized GEA grafting in off-pump coronary artery bypass grafting. These patients represent 41% (168 of 407 patients) of those who underwent off-pump coronary artery bypass grafting operations during the same period. We used the GEA graft of choice in patients with right coronary artery lesion. Skeletonization was performed in a unique manner we developed.
  
  
  RESULTS
  There were no in-hospital deaths among the study patients. One patient had a perioperative myocardial infarction, which was considered a result of vasospasm of the GEA graft. None of the other patients had severe morbidity. The patency rate of the skeletonized GEA graft was 98.1% (151 of 154 distal anastomoses).
  
  
  CONCLUSIONS
  This study suggests that skeletonization of the GEA graft can enlarge its caliber size and improve its flow capacity. In addition, the acceptable early clinical and angiographic outcome suggests that use of the skeletonized GEA graft in off-pump coronary artery bypass grafting surgery is safe and effective.
authors.affiliation: Department of General and Cardiothoracic Surgery, Kanazawa University Hospital, Kanazawa, Japan. hkamiya88@yahoo.co.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kamiya
authors.forename: Go
authors.initials: G
authors.lastname: Watanabe
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Takemura
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Tomita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagamine
authors.forename: Taro
authors.initials: T
authors.lastname: Kanamori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D024405:Gastroepiploic Artery / Q000637:transplantation*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014654:Vascular Patency