Abstract
The right gastroepiploic artery (RGEA) has been used in coronary artery bypass grafting (CABG) as an alternative graft. In particular abdominal surgeries, surgery is required to rescue the graft flow into the coronary artery. A 77-year-old male with a history of CABG using RGEA was admitted with a diagnosis of a large hepatocellular carcinoma (HCC) occupying the whole caudate lobe. Preoperative coronary angiography indicated that the graft from the right internal mammary artery to the proximal left circumflex artery was obliterated among three branch bypasses. Following laparotomy, a great saphenous vein was harvested and delivered from the right axial artery to the RGEA graft over the thoracic wall, and the RGEA graft was ligated and divided. Subsequently, extended left hepatectomy was safely performed. Following hepatectomy, the RGEA graft was restored to the former condition, and the temporary graft was removed. After overcoming hyperbilirubinemia, the patient was discharged on postoperative day 28. This experience indicates that temporary bypass using the long great saphenous vein is effective and safe during long and invasive surgeries.
Highlights
The right gastroepiploic artery (RGEA) has been used in coronary artery bypass grafting (CABG) as an alternative graft [1,2]
We report a case of successful extended left hepatectomy of hepatocellular carcinoma (HCC) using a temporary long great saphenous vein graft to preserve the RGEA graft for CABG
The tumor was too large to be manipulated without removing the RGEA graft, which ran in front of the tumor
Summary
The right gastroepiploic artery (RGEA) has been used in coronary artery bypass grafting (CABG) as an alternative graft [1,2]. After confirming a sufficient blood flow from the axillary artery to the posterolateral branch of the circumflex artery via the temporary saphenous vein graft using transient time flow and Doppler velocity measurements (VeriQ3TM; MediStim, Oslo, Norway), the RGEA graft was ligated and divided just proximal to the anastomosis (Figure 3B). During these procedures, neither ischemic changes nor hemodynamic deterioration were observed on the monitors. (a) Enhanced abdominal computed tomography (CT) showed a large solitary tumor measuring 15 cm in diameter occupying the whole caudate lobe, subsequently pushing up the inferior vena cava (IVC) ventrally (arrow). When last seen at a follow-up consultation 20 months after the surgery, the patient was found to be doing well under treatment with chemotherapy with sorafenib
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