MORPHOMETRIC STUDY OF THE RIGHT GASTROEPIPLOIC AND INFERIOR EPIGASTRIC ARTERIES

Background. Based on earlier observations that the thickness of the in tima and structure of the media may have an impact on the long-term pa tency of arterial conduits and the lack of detailed histologic studies of the right gastroepiploic and inferior epigastric arteries, we subj ected both vessels to morphometric analysis with emphasis on their sui tability as conduits in myocardial revascularization. Methods. The rig ht gastroepiploic and inferior epigastric arteries were harvested from 28 unselected individuals (mean age, 73.2 years) at autopsy, and the luminal diameter and the width of the intima and media were measured. Results. At all levels of measurement (origin, 10 cm, and 15 cm), the luminal diameter of the inferior epigastric artery was significantly s maller than that of the right gastroepiploic artery (p < 0.05). The ri ght gastroepiploic artery demonstrated only mild intimal hyperplasia. In contrast the inferior epigastric artery showed substantial intimal hyperplasia within the first 1-cm segment (mean, 134 +/- 131 mu m vers us 50 +/- 49 mu m for the corresponding segment of the right gastroepi ploic artery; p = 0.01). Intimal hyperplasia was only mild in the rema inder of the inferior epigastric artery. In both vessels, the media wa s muscular with rare dispersed elastic fibers. The mean thickness of t he media ranged from 380 +/- 116 mu m proximally to 155 +/- 70 mu m di stally for the right gastroepiploic artery, and from 316 +/- 86 to 165 +/- 70 mu m, respectively, for the inferior epigastric artery. Conclu sions. In myocardial revascularization, use of the right gastroepiploi c artery may generally be preferable to use of the inferior epigastric artery. This recommendation is based on the larger luminal diameter o f the right gastroepiploic artery as compared with the inferior epigas tric artery, the significantly greater intimal hyperplasia in the firs t segment of the inferior epigastric artery, and the limitation that t he inferior epigastric artery can be used only as a free graft. The ra te of development of intimal hyperplasia in the right gastroepiploic a rtery, if used as an in situ coronary artery bypass graft, may be slow , approximating that of the right gastroepiploic artery in its natural environment. (C) 1997 by The Society of Thoracic Surgeons.