The right gastroepiploic artery graft.

This is the presentation of coronary artery bypass grafting with gastroepiploic artery (GEA) in both skeletonized GEA harvesting technique and anastomosis: After median sternotomy and harvesting internal thoracic artery, the median incision is extended less than one inch. Following laparotomy, dissection of GEA is started from two third distal of the great curvature of the stomach and ended above the pylorus. The GEA is passed into pericardial cavity through a small tunnel in the diaphragm. The most common site of the anastomosis is distal right coronary artery (postero-descending or atrioventricular branch or both). The suture starts from the left side of the "heal" of the GEA and proceeds in a counter-clockwise fashion for three stitches until pulling down the GEA to the coronary artery. After the completion of the anastomosis, the clamp of the GEA is released to check the anastomotic hemostasis. The technique for harvesting skeletonized GEA is shown and an overview of the literature of the CABG using GEA is presented.