A 65-year-old male patient was referred to our hospital for postprandial abdominal pain. Computed tomography and angiography revealed 2 aneurysms of the right gastroepiploic artery, which were measured 0.8x1.3 cm and 1.9x3.4 cm. Excision of 2 saccular and fusiform aneurysms by laparotomy was performed. His hospital course was uneventful and symptoms disappeared after surgery. A gastroepiploic artery aneurysm can cause recurrent abdominal pain and surgical resection is warranted in symptomatic aneurysms.
Abdominal Pain ; Aged ; Aneurysm ; Angiography ; Gastroepiploic Artery ; Humans ; Laparotomy ; Male

Laparoscopic distal gastrectomy has become widespread as a treatment for early gastric cancer in eastern Asia, but a standard method for setting the stomach transection line has not been established. Here we report a novel method of setting this line based on anatomical landmarks. At the start of the operation, two anatomical landmarks along the greater curvature of the stomach were marked with ink: the proximal landmark at the avascular area between the last branch of the short gastric artery and the first branch of the left gastroepiploic artery, and the distal landmark at the point of communication between the right and left gastroepiploic arteries. Just before specimen retrieval, the stomach was transected from the center of these two landmarks toward the lesser curvature. Then, about two-third of the stomach was reproducibly resected, and gastroduodenostomy was successfully performed in 26 consecutive cases. This novel method could be used as a standard technique for setting the transection line in laparoscopic distal gastrectomy.
Arteries ; Far East ; Gastrectomy* ; Gastroepiploic Artery ; Ink ; Stomach Neoplasms ; Stomach*

This is the third in a series on coronary artery bypass which reviews three alternative arterial conduits. The radial artery has become the most widely used of the three and accumulating experience demonstrates better patency at 10 years versus saphenous vein. Drawbacks are a long incision on the forearm, the propensity for spasm and persistent sensory disturbance in about 10%. The first is answered by endoscopic harvest which may yield a shorter conduit but reduces sensory nerve injury. Spasm is managed pharmacologically and by less harvest trauma. The gastroepiploic artery is used in situ and free and although the abdominal cavity is entered complications are minimal and patency compares favorably with the radial artery. Use of the inferior epigastric artery remains minimal and its similar length often requires composite use but limited patency data are supportive. Other arteries have had rare use and this is unlikely to change because the three presented here have significant advantages and acceptance.
Abdominal Cavity ; Arteries ; Coronary Artery Bypass ; Epigastric Arteries ; Forearm ; Gastroepiploic Artery ; Radial Artery ; Saphenous Vein ; Spasm

This is the third in a series on coronary artery bypass which reviews three alternative arterial conduits. The radial artery has become the most widely used of the three and accumulating experience demonstrates better patency at 10 years versus saphenous vein. Drawbacks are a long incision on the forearm, the propensity for spasm and persistent sensory disturbance in about 10%. The first is answered by endoscopic harvest which may yield a shorter conduit but reduces sensory nerve injury. Spasm is managed pharmacologically and by less harvest trauma. The gastroepiploic artery is used in situ and free and although the abdominal cavity is entered complications are minimal and patency compares favorably with the radial artery. Use of the inferior epigastric artery remains minimal and its similar length often requires composite use but limited patency data are supportive. Other arteries have had rare use and this is unlikely to change because the three presented here have significant advantages and acceptance.
Abdominal Cavity ; Arteries ; Coronary Artery Bypass ; Epigastric Arteries ; Forearm ; Gastroepiploic Artery ; Radial Artery ; Saphenous Vein ; Spasm

BACKGROUND: The right gastroepiploic artery(RGEA) has been use in coronary artery bypass grafting from 1987. The RGEA is the most useful arterial conduit in coronary artery bypass grafting(CABG) followed by the internal mammary artery, MATERIALS AND METHOD: From Septermber 1998 to February 1999 the RGEA was used for coronary artery bypass grafting in 11 patients 10 males and 1 female. Postoperative angiography was performed in all of the patients before discharge RESULT: Early patent rate of the RGEA was 100%. The flow competition of the REGA graft was seen in 4 patients(36.4%) The flow pattern war RGEA dependent type in the inner diameter of the recipient coronary artery 1.5 mm the inner diameter of the RGEA 2.5 mm and the rtio of inner diameter of the RGEA and the recipient coronary artery 1(p<0.05) CONCLUSION: Early results of CABG with RGEA was satisfactory. However the RGEA graft has a tendency of flow competition in relation to the inner diameter of graft. Preoperative angiographic evaluation for RGEA and meticulous operative technique are required for a good surgical results.
Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Female ; Gastroepiploic Artery* ; Humans ; Male ; Mammary Arteries ; Transplants*

BACKGROUND: Due to the concern of flow competition or retrograde steal, it has been generally suggested that the right gastroepiploic artery(RGEA) pedicled graft should be used in critical coronary stenosis lesion. The study was designed to evaluate the potential of retrograde flow competition in the RGEA pedicled graft by measuring the native pressure differences(PD) between the normal coronary artery and celiac arterial pressure, which would be compared with trans-stenosis pressure gradients(TSPG) in coronary artery occlusive disease. MATERIAL AND METHOD: Between July, 1998 and February, 1999, pressures of the right coronary artery and the right gastroepiploic artery(or the celiac artery) were measured in patients with the patent right coronary artery(n=12). The PD between the arteries was compared with the TSPG in the occlusive coronary arteries(n=32). RESULT: The pressures of the normal right coronary artery and celiac artery were 143+/-23 vs. 134+/-17mmHg in systole(p<0.005), 74+/-13 vs. 73+/-14mmHg in diastole(p=NS), and 100+/-16 vs. 97+/-15mmHg in mean (p0.05). The PD between the arteries were -8~25mmHg in systole, -4~7 mmHg in diastole, and -1~10mmHg in mean. The TSPG measured in the occlusive coronary arteries were -4~19(7+/-5.8)mmHg in the lesion less than 75% stenosis vs. 7~74(27+/-18.3)mmHg in the 75% or over stenosis lesion(p0.005). The normally existing pressure difference between the coronary arteries and RGEA(15~20mmHg) was significantly less than the TSPG in the occlusive coronary artery with 75% or over stenosis(p0.001). CONCLUSION: If the pressure gradient between the RGEA and the coronary artery distal to the stenosis is the main determinant of development of retrograde flow competiton in the RGEA pedicled graft, the above data suggests that there will be little chance of competition when it is used in the coronary lesion with 75% or over stenosis.
Arterial Pressure ; Arteries ; Celiac Artery ; Constriction, Pathologic ; Coronary Artery Bypass* ; Coronary Stenosis ; Coronary Vessels* ; Diastole ; Gastroepiploic Artery* ; Humans ; Systole ; Transplants*

Throughout its 30-year history, the right gastroepiploic artery (GEA) has been useful for in situ grafts in coronary artery bypass grafting (CABG). The early graft patency rate is high, and the late patency rate has improved by using the skeletonized GEA graft and proper target selection, which involves having a target coronary artery with a tight >90% stenosis. Total arterial revascularization with the internal thoracic artery and GEA grafts is an option for achieving better outcomes from CABG procedures.
Constriction, Pathologic ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Gastroepiploic Artery* ; Mammary Arteries ; Myocardial Ischemia ; Myocardial Revascularization ; Skeleton ; Transplants*

PURPOSE: To identify the importance of the right and left gastric arteries, as well as the gastroepiploic arteries, for the localization of focal gastric lesions from axial images of abdominal MDCTs. MATERIALS AND METHODS: Axial image interpretations from abdominal MDCTs were performed to diagnose the location of focal gastric lesions. The interpretations were performed on 72 patients retrospectively by two radiologists who were blinded from the endoscopic and surgical results by consensus at two different time intervals. No information was provided to the observers, who were asked to determine the precise location of the focal gastric lesion, for the first interpretation. Next, the observers were informed that the right and left gastric arteries, as well as the gastroepiploic arteries, are on the lesser and greater curvature, respectively. Moreover, the gastric angle is on the course of the right and left gastric arteries. One week later, the second interpretation was performed using the same subjects and methods as the first interpretation. The diagnostic accuracy of each interpretation was comparatively evaluated. RESULTS: The diagnostic accuracy of the first and second interpretations was 52.8% (38/72) and 98.6% (71/72), respectively (p < 0.05). CONCLUSION: The results of this study suggest that the right and left gastric arteries, as well as the gastroepiploic arteries, are reliable markers for the localization of the focal gastric lesions on axial images of abdominal MDCTs.
Arteries ; Consensus ; Gastroepiploic Artery ; Humans ; Retrospective Studies ; Stomach ; Tomography, X-Ray Computed

Infected median sternotomy wounds represents one of major complication of cardiothoracic surgery. Although the incidence is less than 1%, its associated morbidity, mortality, and "cost" remain unacceptably high. For the treatment of this recalcitrant wound infections, most patient underwent radical debridement with sternectomy and reconstructed by muscle flaps. The most common combination of flaps being the omentum and bilateral pectoralis major musculocutaneous flaps. In our case, 2 patients who had extensive mediastinal infection at sternotomy wound underwent omental transposition flap pedicled on the right gastroepiploic artery and pectoralis major muscle flap. Omentum has rich lymphatics and high vascularity enough to revascularize the ischemic tissues. Using the greater omentum for infected median sternotomy wound combined with other muscle flap is an useful method for reconstruction of large defects invading lower 1/3 of sternum or retrosternal dead space.
Debridement ; Gastroepiploic Artery ; Humans ; Incidence ; Mortality ; Myocutaneous Flap ; Omentum ; Sternotomy ; Sternum ; Wound Infection ; Wounds and Injuries

In the mid 1980's, the ITA(internal thoracic artery) graft was clearly recognized to be superior to the sapheonous vein graft in respect to long term patency. Therefore, there has been growing interest in the arterial conduit with the possibility of improving the long term result. We have been performing CABG with GEA since 1998 with the same purpose. For mid-term and long-term follow up, we have been performing postoperative coronary angiography. In this paper, a case of GEA spasm, a purported drawback of this conduit, during postoperative coronary anigiography and relieved by direct infusion of 200 microgram isoket into the GEA is reported. The current case which exemplifies the spastic nature of RGEA is accompanied with coronary angiography.
Coronary Angiography* ; Follow-Up Studies ; Gastroepiploic Artery* ; Isosorbide Dinitrate ; Muscle Spasticity ; Spasm* ; Transplants ; Veins