Intraperitoneal bleeding from the right gastroepiploic artery by endoscopic ultrasonography: a case report / Journal of Rural Medicine

Objective: To describe the case of a patient with intraperitoneal bleeding from the gastroepiploic artery by endoscopic ultrasound who was successfully treated with transcatheter arterial coil embolization.Patient and Methods: An 87-year-old man was referred to our hospital for examination of a gallbladder tumor. Endoscopic ultrasonography was performed using an oblique-view echoendoscope. After the endoscopic ultrasound, the patient went into shock. Computed tomography revealed a huge intraperitoneal hematoma and an aneurysm in the right gastroepiploic artery that were not seen on previous computed tomography images. Thus, urgent catheter angiography was performed, which showed a pseudoaneurysm of the right gastroepiploic artery and extravasation of the contrast medium from the pseudoaneurysm.Results: Transcatheter arterial coil embolization was subsequently performed, and the bleeding stopped. Thereafter, his hemodynamics stabilized and his general condition improved. The patient was discharged 22 days post-treatment with an uneventful course.Conclusion: Observation-only endoscopic ultrasound without invasive procedures can cause intraperitoneal bleeding due to a ruptured splanchnic artery. Thus, endoscopic ultrasonography should be performed more carefully in elderly patients.

Vascular anatomy of the stomach and its application in gastric tube reconstruction dur-ing esophagectomy / 中国肿瘤临床

Objective: To investigate the vascular anatomy of the stomach, especially the right gastroepiploic artery for the reconstruc-tion of a gastric tube during esophagectomy. Methods: The vascular anatomy of the stomach was studiing in 28 embalmed human specimens provided by the Department of Anatomy, Shanghai Medical College, Fudan University, included 10 female and 18 male spec-imens. The length and diameter of gastric vessels were measured. The ratio of the length of the right gastroepiploic artery to the length of the greater curvature was calculated. Anastomosis between the left and right gastroepiploic arteries was also assessed. Re-sults: Twenty-five left gastric arteries were observed in the autopsies, with the mean diameter of 3.40 (2.10-6.40) mm. Twenty-one right gastric arteries were measured, with the mean diameter of 1.97 (0.68-3.56) mm. Twenty-six left gastroepiploic arteries were ob-served, with the mean diameter of 1.87 (0.80-2.96) mm. Twenty-eight right gastroepiploic arteries were measured, with the mean di-ameter of 2.82 (1.58-4.80) mm. The mean lengths of the 28 right gastroepiploic arteries and their greater curvatures were 216.71 (120-318) mm and 356.39 (248-487) mm, respectively. The ratio of the length of right gastroepiploic arteries and greater curvatures was 0.61 (0.45-0.82). The anastomosis between the left and right gastroepiploic arteries was observed in 60.7% (17/28) of the specimens. Conclusions: The length and diameter of gastric vessels were calculated. It was assumed that the right gastroepiploic artery provides an average of 61% of the blood supply for the great curvature. In addition, the anastomotic branch of the right and left gastroepiploic arteries was observed in 60.7% specimens. These anatomical data allow surgeons to estimate the blood supply and to choose an opti-mal method of gastric tube reconstruction during esophagectomy.

Spontaneous rupture of right gastroepiploic artery aneurysm: a rare cause of hemorrhagic shock. case report

ABSTRACT CONTEXT: Aneurysms of the gastroepiploic arteries are seen only rarely. They are usually diagnosed during autopsy or laparotomy in patients with hemodynamic instability. Although the operation to treat this condition is relatively easy, delay in making the diagnosis affects the course of the disease. Case Report: A 57-year-old woman was admitted to the emergency department with abdominal pain and unconsciousness. A computed tomography scan showed extravasation of contrast agent at the headcorpus junction of the pancreas, and the patient underwent exploratory laparotomy under general anesthesia. During laparotomy, aneurysmatic rupture of the right gastroepiploic artery was detected. Control over bleeding was achieved by ligating the right gastroepiploic artery at its origin. The aneurysm was also resected and sent for pathological examination. CONCLUSION: Especially in cases of unidentified shock, splanchnic artery aneurysms should be kept in mind. Moreover, in the light of the data in the literature, the possibility of death should be taken into account seriously and, if feasible, prophylactic aneurysmectomy should be performed.

Total Arterial Off-Pump Coronary Artery Bypass Grafting: A 10-Year Experience / 中华医学杂志(英文版)

<p><b>Background</b>Arterial grafts had better mid-term and long-term patency than saphenous vein grafts in coronary artery bypass grafting (CABG). We summarized our experience with total arterial off-pump coronary artery bypass grafting (OPCAB) and assessed the early clinical results, surgical complications, and follow-up.</p><p><b>Methods</b>From January 2007 to May 2017, 508 coronary artery disease patients undergoing total arterial OPCAB were enrolled. Clinical features, approaches, outcomes of surgical treatments, and follow-up data of these patients were studied retrospectively. A total of 122 patients underwent single left internal mammary artery (IMA)-left anterior descending artery grafts, whereas the other 386 patients underwent multiple vessel grafts.</p><p><b>Results</b>The average distal anastomosis was 2.34 ± 0.97 (range: 1-4). All the patients were discharged from hospital except one died. A total of 457 (90.32%) patients were followed up. In the 4-, 7-, and 10-year follow-up groups, the rate of death from any cause was 1.19%, 6.47%, and 10.67%; rate of cardiac death was 0.60%, 2.88%, and 3.33%; rate of repeat revascularization was 0.00%, 3.60%, and 8.67%; rate of ischemic symptoms was 1.79%, 7.91%, and 11.33%; and incidence of stroke was 2.38%, 4.32%, and 6.67%, respectively. Poor medication adherence was observed in 9.38% of the follow-up population.</p><p><b>Conclusions</b>Total arterial OPCAB with bilateral IMA, radial artery, and right gastroepiploic artery grafting yielded satisfactory early and midterm outcomes in this patient group, without a significant increase in early mortality or morbidity. Moreover, the long-term outcomes are also positive.</p>

The Right Gastroepiploic Artery Graft for Coronary Artery Bypass Grafting: A 30-Year Experience

Throughout its 30-year history, the right gastroepiploic artery (GEA) has been useful for in situ grafts in coronary artery bypass grafting (CABG). The early graft patency rate is high, and the late patency rate has improved by using the skeletonized GEA graft and proper target selection, which involves having a target coronary artery with a tight >90% stenosis. Total arterial revascularization with the internal thoracic artery and GEA grafts is an option for achieving better outcomes from CABG procedures.

Conduits for Coronary Bypass: Arteries Other Than the Internal Thoracic Artery's

This is the third in a series on coronary artery bypass which reviews three alternative arterial conduits. The radial artery has become the most widely used of the three and accumulating experience demonstrates better patency at 10 years versus saphenous vein. Drawbacks are a long incision on the forearm, the propensity for spasm and persistent sensory disturbance in about 10%. The first is answered by endoscopic harvest which may yield a shorter conduit but reduces sensory nerve injury. Spasm is managed pharmacologically and by less harvest trauma. The gastroepiploic artery is used in situ and free and although the abdominal cavity is entered complications are minimal and patency compares favorably with the radial artery. Use of the inferior epigastric artery remains minimal and its similar length often requires composite use but limited patency data are supportive. Other arteries have had rare use and this is unlikely to change because the three presented here have significant advantages and acceptance.

Conduits for Coronary Bypass: Arteries Other Than the Internal Thoracic Artery's

This is the third in a series on coronary artery bypass which reviews three alternative arterial conduits. The radial artery has become the most widely used of the three and accumulating experience demonstrates better patency at 10 years versus saphenous vein. Drawbacks are a long incision on the forearm, the propensity for spasm and persistent sensory disturbance in about 10%. The first is answered by endoscopic harvest which may yield a shorter conduit but reduces sensory nerve injury. Spasm is managed pharmacologically and by less harvest trauma. The gastroepiploic artery is used in situ and free and although the abdominal cavity is entered complications are minimal and patency compares favorably with the radial artery. Use of the inferior epigastric artery remains minimal and its similar length often requires composite use but limited patency data are supportive. Other arteries have had rare use and this is unlikely to change because the three presented here have significant advantages and acceptance.

Physiological and Functional Evaluation of the Transposed Human Pylorus as a Distal Sphincter

BACKGROUND/AIMS: Studies evaluating the human pylorus as a sphincter are scanty and contradictory. Recently, we have shown technical feasibility of transposing the human pylorus for end-stage fecal incontinence. This unique cohort of patients provided us an opportunity to study the sphincter properties of the pylorus in its ectopic position. METHODS: Antro-pylorus transposition on end sigmoid colostomies (n = 3) and in the perineum (n = 15) was performed for various indications. Antro-pylorus was assessed functionally (digital examination, high resolution spatiotemporal manometry, barium retention studies and colonoscopy) and by imaging (doppler ultrasound, MRI and CT angiography) in its ectopic position. RESULTS: The median resting pressure of pylorus on colostomy was 30 mmHg (range 28-38). In benign group, median resting pressure in perineum was 12.5 mmHg (range 6-44) that increased to 21.5 mmHg (range 12-29) (P = 0.481) and 31 mmHg (range 16-77) (P = 0.034) on first and second follow-up, respectively. In malignant group, median post-operative pressures were 20 mmHg (range 14-36) and 21 mmHg (range 18-44) on first and second follow-up, respectively. A definite tone and gripping sensation were felt in all the patients on digital examination. On distal loopogram, performed through the diverting colostomies, barium was retained proximal to the neo-pyloric valve. Both perineal ultrasound and MRI showed viable transposed graft. CT angiography and color doppler studies confirmed vascular flow in the transposed position. CONCLUSIONS: The human pyloric valve can function as a tonic sphincter when removed from the gastroduodenal continuity.

Dexmedetomidine does not produce vasocontraction on human isolated gastroepiploic artery / 대한마취과학회지

BACKGROUND: Recently, the addition of dexmedetomidine to sedation regimens after cardiac surgery had been reported and there is a possibility that dexmedetomidine can cause vasoconstriction. Vasopressin has been used as a prophylactic treatment for refractory vasodilatory shock during coronary artery bypass graft (CABG). Also, vasopressin may play an important role in initiating spasms at the graft artery. Here we evaluate the direct effect of dexmedetomidine on isolated human gastroepiploic arteries and the synergistic effect of dexmedetomidine and vasopressin. METHODS: Discarded gastroepiploic arteries from elective subtotal gastrectomy (n = 10) were used in this study. We measured the level of contraction in isolated human gastroepiploic arteries induced by increasing concentrations of dexmedetomidine (10(-10) to 10(-6) M) with or without vasopressin (10(-10), 10(-9) M). Arterial contractions caused by increasing concentrations of vasopressin (10(-10) to 10(-7.5) M) with or without dexmedetomidine (10(-9), 10(-7) M) were also measured in the tissue samples. RESULTS: Supraclinical concentrations of dexmedetomidine elicited contractions at concentrations of 10(-7) M and 10(-6) M (P < 0.05 versus resting tension). The same concentrations of dexmedetomidine (10(-7), 10(-6) M) significantly enhanced vasopressin-induced contractions (P < 0.05 versus vasopressin-induced contraction). Vasopressin produced concentration-dependent contractions and vasopressin (10(-10), 10(-9.5), 10(-9) M) also increased the intensity of dexmedetomidine (10(-7) M) induced contractions. CONCLUSIONS: There was a synergistic effect between supraclinical doses of dexmedetomidine and vasopressin on the degree of contraction in isolated human gastroepiploic arteries. However, a sedative dose of dexmedetomidine (clinical dose: 0.2-0.7 microg/kg/hr, plasma concentration: 0.36-1.25 ng/ml) did not enhance vasopressin induced-contraction in isolated human gastroepiploic arteries.

Hepatic Artery Reconstruction Using the Right Gastroepiploic Artery for Hepatic Artery Inflow in a Living Donor Liver Transplantation / 대한이식학회지

Securing the source of hepatic artery inflow is essential for living donor liver transplantation. However, sometimes, the hepatic arteries of the recipients are in poor condition for a good anastomosis in living donor liver transplantation; problems include severe arteriosclerosis, intimal dissection, and significant intimal injuries caused by previous transarterial procedures. In these conditions, the right gastroepiploic artery has generally been the preferred artery because of its anatomical location, size and length. Here, a case of successful hepatic artery reconstruction is reported using the right gastroepiploic artery in living donor liver transplantation. The recipient's hepatic arterial intima was severely injured by multiple transarterial chemoembolization and unsuitable for reconstruction. Instead, the right gastroepiploic artery was anastomosed to the hepatic artery of the graft. Arterial blood flow was satisfactory on Doppler ultrasonography during the operation, and complications related to the hepatic artery were not detected during the follow-up period. Therefore, the right gastroepiploic artery may be considered as a suitable alternative for hepatic artery reconstruction in living donor liver transplantation.

The Application of Multi-slice Spiral CT Angiogrpahy in Showing the Right Gastroepiploic Artery / 实用放射学杂志

Objective To evaluate the clinical value of MSCTA in displaying the right gastroepiploic artery(RGEA).Methods 16-slice spiral CT enhanced images of abdomen in 80 cases were retrospectively reviewed.The course and the length of RGEA were observed and the diameters of RGEA at the origin and the end were also measured on maximum intensity projection(MIP),thin slice maximum intensity projection(TSMIP) and volume rendering(VR) images.Results The displaying rate of RGEA by MSCTA was 100% including long type in 22 cases(27.50%),moderate type in 53 cases(66.25%) and short type in 5 cases(6.25%).The average length of RGEAs was (19.5±4.5) cm.The average diameters of RGEAs at the origin in long,moderate and short type respectively were (2.69±0.26) mm,(2.70±0.18) mm,(2.68±0.12) mm respectively.The average diameters of RGEAs at the end in these three types were (1.76±0.17) mm,(1.75±0.18) mm and (1.74±0.05) mm respectively.The average diameters of RGEA in different length were no of statistical significance(P＞0.05).Conclusion RGEA can be evaluated with MSCTA before coronary artery bypass grafting.

A Right Gastroepiploic Artery Aneurysm Treated by Surgical Excision

A 65-year-old male patient was referred to our hospital for postprandial abdominal pain. Computed tomography and angiography revealed 2 aneurysms of the right gastroepiploic artery, which were measured 0.8x1.3 cm and 1.9x3.4 cm. Excision of 2 saccular and fusiform aneurysms by laparotomy was performed. His hospital course was uneventful and symptoms disappeared after surgery. A gastroepiploic artery aneurysm can cause recurrent abdominal pain and surgical resection is warranted in symptomatic aneurysms.

Localization of the Focal Gastric Lesion on Abdominal MDCT: The Importance of the Right and Left Gastric Arteries and Gastroepiploic Arteries

PURPOSE: To identify the importance of the right and left gastric arteries, as well as the gastroepiploic arteries, for the localization of focal gastric lesions from axial images of abdominal MDCTs. MATERIALS AND METHODS: Axial image interpretations from abdominal MDCTs were performed to diagnose the location of focal gastric lesions. The interpretations were performed on 72 patients retrospectively by two radiologists who were blinded from the endoscopic and surgical results by consensus at two different time intervals. No information was provided to the observers, who were asked to determine the precise location of the focal gastric lesion, for the first interpretation. Next, the observers were informed that the right and left gastric arteries, as well as the gastroepiploic arteries, are on the lesser and greater curvature, respectively. Moreover, the gastric angle is on the course of the right and left gastric arteries. One week later, the second interpretation was performed using the same subjects and methods as the first interpretation. The diagnostic accuracy of each interpretation was comparatively evaluated. RESULTS: The diagnostic accuracy of the first and second interpretations was 52.8% (38/72) and 98.6% (71/72), respectively (p < 0.05). CONCLUSION: The results of this study suggest that the right and left gastric arteries, as well as the gastroepiploic arteries, are reliable markers for the localization of the focal gastric lesions on axial images of abdominal MDCTs.

Gastroepiploic Artery Preservation with Glycerol as a Training Model for Microvascular Anastomosis

PURPOSE: We investigate the possibility of vessel preservation with glycerol and evaluate the potential of preserved gastroepiploic artery as a tool for the microsurgical practice. METHODS: In 5 early gastric cancer patients, IRB(No. C-0603-040-170), we gained gastroepiploic artery specimens(5 segments, about 10cm) after gastrectomy. Each segment was rinsed in a normal saline and subsequently placed in a bottle, containing 50mL anhydrous glycerol (87%). The bottles were refrigerated at 4degrees C, the longest preservation time being 5 months. RESULTS: At first glance, no fragmentation was detected and the surface of vessel seemed mild sclerotic. In histological examination, vascular structures remained intact though preservation with glycerol led to a mild atrophy of the smooth muscle in the tunica media. Especially, we found out the elastic fibers and endothelial lining of the intima were preserved until 5 months. Adequate status for using microsurgical practice was also maintained and leakage test was performed successfully with gentian violet ink. CONCLUSION: Based on the results obtained in this study, the gastroepiploic artery preservation with glycerol as a training model for microvascular anastomosis is a technically very simple procedure and useful for the novice microsurgeon.

Availability of the Skeletonized Gastroepiploic Artery as a Free Graft for Coronary Artery Bypass Grafting / 대한흉부외과학회지

BACKGROUND: To maximize the histological advantage and minimize the physiological disadvantage, we have been using the skeletonized gastroepiploic artey (GEA) as a free graft for total arterial revascularization. The aims of the current study was to assess the efficacy of the skeletonized GEA as a composite or extended graft for total arterial revascularization. MATERIAL AND METHOD: Between January 2000 and Feburary 2005, 133 patients (43 female, mean age=61.8 yrs) undergoing coronary artery bypass grafting (CABG) with a skeletonized GEA as free graft (22 extended, 107 composite and 4 others) were enrolled in this study. Coronary angiograms were performed in the immediate (median 14 days, n=86), early (median 366 days, n=56) and midterm (median 984 days, n=29) postoperative periods. RESULT: There were 3 (2.2%) early and 4 (3.3%) late cardiac-related deaths. The mean number of distal anastomoses per patient was 3.34 for total graft and 1.92 for GEA graft. The immediate, early, and midterm GEA patency were 157/159 (98.7%), 106/112 (94.6%), and 53/56 (94.6%), respectively. During follow-up, four patients required percutaneous intracoronary intervention because of GEA and target coronary artery stenosis or competitive flow. CONCLUSION: These data demonstrate satisfactory clinical and angiographic results in the skeletonized GEA as free graft for total arterial revascularization. Although we need a careful longer follow-up, the skeletonized GEA as a free graft will be a valuable option 'to be' for CABG.

Stomach Cancer Surgery after Coronary Artery Bypass Surgery with in situ Right Gastroepiploic Artery Graft / 대한흉부외과학회지

A 59 year-old male diagnosed as unstable angina underwent off-pump coronary artery bypass surgery using in situ left internal mammary and right gastroepiploic artery grafts. During harvesting the right gastroepiploic artery, there was no abnormal finding in intraabdominal organs including stomach and liver. He was discharged at the 3rd postoperative day without complication. In case of using in situ right gastroepiploic artery, we recommend gastrofiberscopic study at regular follow-up. The patient underwent the gastrofiberscopic study at postoperative 3rd month and diagnosed as advanced gastric cancer on the posterior wall of gastric fundus. At 5th postoperative month, total gastrectomy without intraoperative injury of the right gastroepiploic artery was performed at the department of general surgery. He was discharged at the 9th postoperative day. Follow-up coronary angiography performed at the 1st postoperative year demonstrated patent grafts including right gastroepiploic artery.

Off-Pump Total Arterial Revascularization Using the Skeletonized Right Gastroepiploic Artery as a Third Arterial Conduit; Early and Midterm Results / 대한흉부외과학회지

BACKGROUND: The aim of this study was to evaluate the early and midterm results of off-pump total arterial revascularization using the skeletonized right gastroepiploic artery (RGEA) as a third arterial conduit. MATERIAL AND METHOD: We prospectively analyzed 103 patients who underwent off-pump total arterial revascularization using bilateral internal thoracic arteries (ITAs) and RGEA. The RGEA was used as in situ graft in 88 patients, composite graft in 10 patients, and free graft in 5 patients. Postoperative coronary angiographies were performed before discharge in 100 patients, and at postoperative one year in 88 patients. RESULT: The RGEA showed a significantly higher free flow (130+/-95 ml/min) than that of right ITA (113+/-57 ml/min) or left ITA (107+/-55 ml/min), which was measured before anastomosis (p<0.05). The total number of distal anastomoses was 3.8+/-0.7. The number of distal anastomoses per bilateral ITAs was 2.8+/-0.7 and the number of distal anastomosis per RGEA was 1.0. There were two mortalities including one operative mortality. The late mortality was not related to cardiac events. Early postoperative morbidities were atrial fibrillation in 15 patients, bleeding reoperation in 4 patients, mediastinitis in 1 patients, perioperative myocardial infarction in 2 patient, and transient ARF in 3 patients. Postoperative coronary angiographies showed the early patency rate of 98.6% (272/276) for ITAs and 97.0% (97/100) for RGEA, respectively (p=ns), and the one-year patency rate of 95.9% (234/244) for ITAs and 88.6% (78/88) for RGEA, respectively (p=0.07). Flow competition between the RGEA and NCA (native coronary artery) was seen in 5 of the 100 patients (5.0%) immediate postoperatively and 7 of the 88 patients (8.0%) 1 year after surgery. Since July, 2000, we measured transit time flow intraoperatively and could reduce flow competition significantly. CONCLUSION: The skeletonized RGEA demonstrated excellent early and midterm patency rates and could be used as a third arterial graft following the bilateral ITAs.

Evaluation of the Potential of Retrograde Flow Competition in the Right Gastroepiploic Artery Graft for Coronary Artery Bypass Grafting / 대한흉부외과학회지

BACKGROUND: Due to the concern of flow competition or retrograde steal, it has been generally suggested that the right gastroepiploic artery(RGEA) pedicled graft should be used in critical coronary stenosis lesion. The study was designed to evaluate the potential of retrograde flow competition in the RGEA pedicled graft by measuring the native pressure differences(PD) between the normal coronary artery and celiac arterial pressure, which would be compared with trans-stenosis pressure gradients(TSPG) in coronary artery occlusive disease. MATERIAL AND METHOD: Between July, 1998 and February, 1999, pressures of the right coronary artery and the right gastroepiploic artery(or the celiac artery) were measured in patients with the patent right coronary artery(n=12). The PD between the arteries was compared with the TSPG in the occlusive coronary arteries(n=32). RESULT: The pressures of the normal right coronary artery and celiac artery were 143+/-23 vs. 134+/-17mmHg in systole(p<0.005), 74+/-13 vs. 73+/-14mmHg in diastole(p=NS), and 100+/-16 vs. 97+/-15mmHg in mean (p0.05). The PD between the arteries were -8~25mmHg in systole, -4~7 mmHg in diastole, and -1~10mmHg in mean. The TSPG measured in the occlusive coronary arteries were -4~19(7+/-5.8)mmHg in the lesion less than 75% stenosis vs. 7~74(27+/-18.3)mmHg in the 75% or over stenosis lesion(p0.005). The normally existing pressure difference between the coronary arteries and RGEA(15~20mmHg) was significantly less than the TSPG in the occlusive coronary artery with 75% or over stenosis(p0.001). CONCLUSION: If the pressure gradient between the RGEA and the coronary artery distal to the stenosis is the main determinant of development of retrograde flow competiton in the RGEA pedicled graft, the above data suggests that there will be little chance of competition when it is used in the coronary lesion with 75% or over stenosis.

Arterry Bypas Graft with the Right Gastroepiploic Artery: Clinical and Angiographic Short-Term Results / 대한흉부외과학회지

BACKGROUND: The right gastroepiploic artery(RGEA) has been use in coronary artery bypass grafting from 1987. The RGEA is the most useful arterial conduit in coronary artery bypass grafting(CABG) followed by the internal mammary artery, MATERIALS AND METHOD: From Septermber 1998 to February 1999 the RGEA was used for coronary artery bypass grafting in 11 patients 10 males and 1 female. Postoperative angiography was performed in all of the patients before discharge RESULT: Early patent rate of the RGEA was 100%. The flow competition of the REGA graft was seen in 4 patients(36.4%) The flow pattern war RGEA dependent type in the inner diameter of the recipient coronary artery 1.5 mm the inner diameter of the RGEA 2.5 mm and the rtio of inner diameter of the RGEA and the recipient coronary artery 1(p<0.05) CONCLUSION: Early results of CABG with RGEA was satisfactory. However the RGEA graft has a tendency of flow competition in relation to the inner diameter of graft. Preoperative angiographic evaluation for RGEA and meticulous operative technique are required for a good surgical results.

Right Gastroepiploic Artery Spasm during Pst-CABG Coronary Angiography / 대한흉부외과학회지

In the mid 1980's, the ITA(internal thoracic artery) graft was clearly recognized to be superior to the sapheonous vein graft in respect to long term patency. Therefore, there has been growing interest in the arterial conduit with the possibility of improving the long term result. We have been performing CABG with GEA since 1998 with the same purpose. For mid-term and long-term follow up, we have been performing postoperative coronary angiography. In this paper, a case of GEA spasm, a purported drawback of this conduit, during postoperative coronary anigiography and relieved by direct infusion of 200 microgram isoket into the GEA is reported. The current case which exemplifies the spastic nature of RGEA is accompanied with coronary angiography.