title: Transit-time flow characteristics of in situ right gastroepiploic arterial grafts in coronary artery bypass grafting.
abstract: OBJECTIVE
  We investigated flow characteristics of right gastroepiploic arterial grafts, widely used to extend in situ arterial conduits in coronary artery bypass grafting.
  
  
  METHODS
  Intraoperative transit-time measurements and postoperative angiographic findings were obtained for 111 patients undergoing coronary artery bypass grafting with gastroepiploic artery and bilateral internal thoracic arteries: mean, maximum, and minimum flows; pulsatility index; insufficiency rate; and differentiated index of early diastolic flow.
  
  
  RESULTS
  Favored target for gastroepiploic artery was posterior descending artery (106 patients, 95%). Patency rates were 91.0% for gastroepiploic artery, 98.2% for left internal thoracic artery, and 97.5% for right internal thoracic artery. There were four flow profiles of gastroepiploic arteries: A (systolic protruded), B (trapezoidal), C (sine waved), and D (diastolic-dominant biphasic). Functional gastroepiploic arteries showed A in 16 cases, B in 6, C in 31, and D in 48, with prevalence according to severity of stenosis in target coronary artery. Two occluded gastroepiploic arteries showed type A, and reverse or competitive flows were types A in 1, B in 1, C in 4, and D in 2. Relative to functional internal thoracic arteries, functional gastroepiploic arteries showed significantly lower minimum flow, higher insufficiency rate, and lower differentiated index of early diastolic flow.
  
  
  CONCLUSIONS
  Intraoperative transit-time flow profiles of patent in situ gastroepiploic arterial grafts were classified into four types, closely associated with disease severity of target coronary artery. Patent in situ gastroepiploic arterial grafts show more regurgitant flow and lower differentiated index of early diastolic flow than in situ internal thoracic arterial grafts.
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan. takami@nagoya2.jrc.or.jp
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takami
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tajima
authors.forename: Sachie
authors.initials: S
authors.lastname: Terazawa
authors.forename: Noritaka
authors.initials: N
authors.lastname: Okada
authors.forename: Kei
authors.initials: K
authors.lastname: Fujii
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Sakai
mesh_terms: D000792:Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D024405:Gastroepiploic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011182:Postoperative Care; D011673:Pulsatile Flow; D013997:Time Factors; D014654:Vascular Patency