The right gastroepiploic artery graft

The right gastroepiploic artery (RGEA) conduit is the only other in situ arterial graft available for use in coronary artery bypass graft surgery other than the internal thoracic artery. Total arterial revascularization using only pedicled grafts can be achieved using the RGEA in combination with the bilateral internal thoracic artery in three-vessel disease. Early graft patency rate is high and the late patency rate is excellent when the RGEA is harvested by the skeletonized technique and deployed to target coronary arteries with severe stenosis (>90%). Abdominal complications are rare since only a small laparotomy is required. Late graft disease is uncommon in the RGEA conduit. At repeat coronary artery bypass graft surgery involving solely the right coronary artery territory, a small laparotomy approach using the RGEA can be performed with an off-pump technique without sternotomy. The RGEA conduit also can be used as a free or composite graft if the RGEA had low free flow, or if intraoperative flow measurement suggested a competitive flow pattern.