Histological and Morphometric Properties of Skeletonized Gastroepiploic Artery and Risk Factors for Intimal Hyperplasia

OBJECTIVE: The aim of the present study was to examine the histological and morphometric properties of skeletonized gastroepiploic artery (GEA) and the risk factors for intimal hyperplasia. METHODS: We obtained the redundant distal segments of skeletonized GEAs from 33 patients undergoing coronary bypass surgery and microscopically examined the transverse sections just distal to the most distal anastomoses. Intimal hyperplasia was evaluated on the basis of intima-to-media ratio and percentage of luminal narrowing. Risk factors were examined using multivariate linear regression analysis. RESULTS: The median (range) of lumen diameter at the most distal anastomosis was 3.8 (2.4-6.4) mm; width of intima, 82 (8-418) μm; width of media, 167 (88-351) μm; wall thickness, 250 (118-554) μm; intima-to-media ratio, 0.59 (0.04-3.88), and percentage of luminal narrowing, 12.3 (1.5-28.9). The number of elastic lamina in the media was 4.2 ± 1.8. Atherosclerosis was found in six patients, and medial calcification, in three patients. The median (range) of graft flow and pulsatile index measured by intraoperative transit-time flow meter was 65 (11-141) mL/min and 3.1 (1.4-5.9), respectively. All GEA grafts were patent at the coronary computed tomography angiography before discharge. Estimated glomerular filtration rate was independently associated with intima-to-media ratio (β coefficient = -0.016, P < 0.01) and percentage of luminal narrowing (β coefficient = -0.012, P < 0.01). CONCLUSIONS: Skeletonized GEA had sufficient lumen diameter with excellent graft flow and early patency even when used as a sequential graft. Estimated glomerular filtration rate correlates significantly with intimal hyperplasia.