Composite free gastroepiploic artery graft for off-pump coronary artery bypass grafting with celiac artery or superior mesenteric artery stenosis: A report of two cases

INTRODUCTION: We report two cases of off-pump coronary artery bypass grafting (CABG) with celiac artery (CA) or superior mesenteric artery (SMA) stenosis using skeletonized gastroepiploic artery (GEA) grafts. PRESENTATION OF CASE: A 77-year-old man (case 1) and a 49-year-old man (case 2) underwent off-pump CABG for unstable angina. Preoperative ultrasonography revealed CA or SMA stenosis; therefore, we chose a free GEA composite with an internal thoracic artery (ITA) graft instead of an in-situ GEA graft. The patients were ultimately discharged uneventfully. DISCUSSION: GEA graft are remarkably reliable; however, their frequency of use seems to have decreased. In some cases, before GEA harvesting, echocardiogram shows accelerated peak systolic velocity (PSV) in the CA or SMA suggesting vascular stenosis, which prompts relinquishing GEA use. Therefore, free GEA grafts and composite of ITA graft were chosen recently. CONCLUSION: Free GEA grafts are especially advantageous for patients with peripheral artery disease who are unsuitable for saphenous vein harvesting. Free GEA grafting could be an alternative modality to avoid aortic clamping in patients with severe atherosclerotic lesions. The routine use of echocardiogram to evaluate blood flow in the CA and SMA should be advocated, as it often shows accelerated PSV (greater than 150 cm/s), which suggests vascular stenosis.