*5.3.3 Right gastroepiploic artery*

It is very rarely used as an arterial graft when other conduits are not available. To harvest this artery, the midline incision over the sternum is extended to the upper abdomen, and the abdominal cavity is opened. There are two gastroepiploic arteries (**Figure 5**): left and right. Both arteries participate in the stomach vascularization and are collateral blood circulation with other blood vessels of the stomach. Harvesting right gastroepiploic artery as conduit does not compromise stomach blood supply. Branches of this artery to the stomach and omentum are ligated and divided. This artery is positioned either anteriorly or posteriorly to the duodenum

**Figure 5.** *Gastroepiploic artery.*

The radial artery can be harvested by open conventional method or endoscopically. The radial artery should be flushed and kept in a solution prepared with Ringer lactate (500 ml), sodium nitroprusside (50 mg), and heparinized blood (30 ml).

*Relationship of LIMA with sternum, thoracic muscles, pleura, and endothoracic fascia.*

**Figure 2.**

**Figure 3.**

**86**

*Internal mammary artery course.*

*The Current Perspectives on Coronary Artery Bypass Grafting*

and stomach, depending on the tension on graft. A circular opening is made in the diaphragm, medial to the inferior vena cava, and the gastroepiploic artery is passed through this opening to anastomose it with RCA or PDA coronary arteries. The anatomy of gastroepiploic arteries is presented in **Figure 6**.

*5.3.6 Splenic artery*

**5.4 Venous grafts**

*5.4.1 Greater saphenous vein*

of this type of graft based on:

simplifies its harvest.

**Figure 7.** *Splenic artery.*

**89**

When there is lack of other conduit, the splenic artery can be used for grafting.

The greater saphenous vein (**Figure 8**) is the most commonly used conduit for CABG. The greater saphenous vein (GSV) of the lower extremity is the best choice

• There are two independent types of low extremity vein system, and removal of superficial one (GSV) does not jeopardize the venous flow from the leg.

• Position, diameter, and length of the GSV are in constant pattern which

Usually a single long segment is harvested. About 12–15 cm segment may be needed for diagonal branch, about 20–24 cm length for OM branches, and 18–22 cm

The same as harvesting gastroepiploic artery, midline sternal incision can be extended over the abdomen, and the abdomen is opened. Then lesser peritoneal sac is opened. The splenic artery (**Figure 7**) runs along the superior margin of the pancreas. Branches to the pancreas are ligated and divided. Then the splenic artery is ligated and divided at the splenic hilum and passed through an opening made in

*Coronary Artery Bypass Grafting: Surgical Anastomosis: Tips and Tricks*

the diaphragm medial to the inferior vena cava.

*DOI: http://dx.doi.org/10.5772/intechopen.88932*

## *5.3.4 Inferior epigastric artery*

The inferior epigastric artery (**Figure 6**) arises from the medial aspect of the external iliac artery and gives branches to the spermatic cord, pubis, abdominal muscles, and skin. Its harvesting requires additional either low midline, or paramedian, or oblique inguinal approach. The anterior sheath of the rectus muscle is divided, and then the muscle is pushed medially. The artery is harvested along with the accompanying veins as a pedicle graft and kept in the solution as mentioned for radial artery preservation.

When the length of this artery is not sufficient for an independent graft, it is used as a composite graft with the LIMA as extension graft.

#### *5.3.5 Ulnar artery*

Occasionally, when surgeons do not have other choice, they use the ulnar artery as arterial conduit.

**Figure 6.** *Inferior epigastric artery.*

*Coronary Artery Bypass Grafting: Surgical Anastomosis: Tips and Tricks DOI: http://dx.doi.org/10.5772/intechopen.88932*

## *5.3.6 Splenic artery*

and stomach, depending on the tension on graft. A circular opening is made in the diaphragm, medial to the inferior vena cava, and the gastroepiploic artery is passed through this opening to anastomose it with RCA or PDA coronary arteries. The

The inferior epigastric artery (**Figure 6**) arises from the medial aspect of the external iliac artery and gives branches to the spermatic cord, pubis, abdominal muscles, and skin. Its harvesting requires additional either low midline, or

paramedian, or oblique inguinal approach. The anterior sheath of the rectus muscle is divided, and then the muscle is pushed medially. The artery is harvested along with the accompanying veins as a pedicle graft and kept in the solution as men-

When the length of this artery is not sufficient for an independent graft, it is

Occasionally, when surgeons do not have other choice, they use the ulnar artery

anatomy of gastroepiploic arteries is presented in **Figure 6**.

*The Current Perspectives on Coronary Artery Bypass Grafting*

used as a composite graft with the LIMA as extension graft.

*5.3.4 Inferior epigastric artery*

tioned for radial artery preservation.

*5.3.5 Ulnar artery*

as arterial conduit.

**Figure 6.**

**88**

*Inferior epigastric artery.*

When there is lack of other conduit, the splenic artery can be used for grafting. The same as harvesting gastroepiploic artery, midline sternal incision can be extended over the abdomen, and the abdomen is opened. Then lesser peritoneal sac is opened. The splenic artery (**Figure 7**) runs along the superior margin of the pancreas. Branches to the pancreas are ligated and divided. Then the splenic artery is ligated and divided at the splenic hilum and passed through an opening made in the diaphragm medial to the inferior vena cava.
