Distal gastrectomy for advanced gastric cancer with vascular anomaly after coronary bypass grafting using the right gastroepiploic artery

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• 作者：Masaki Kunizaki M.D. ; Ph.D. ; ^a ; ^{makuni49@nagasaki-u.ac.jp"" rel=""nofollow} ; Shigekazu Hidaka M.D. ; Ph.D.^a ; Takashi Nonaka M.D.^a ; Katsunori Takagi M.D.^a ; Syuichi Tobinaga M.D.^a ; Hiroaki Takeshita M.D. ; Ph.D.^a ; Atsushi Nanashima M.D. ; Ph.D.^a ; Terumitu Sawai M.D. ; Ph.D.^a ; Toru Yasutake M.D. ; Ph.D.^a ; Takeshi Nagayasu M.D. ; Ph.D.^a
• 关键词：Right gastroepiploic artery ; Gastric cancer ; Coronary artery bypass grafting
• 刊名：The American Journal of Surgery
• 出版年：2011
• 出版时间：May 2011
• 年：2011
• 卷：201
• 期：5
• 页码：e35-e37
• 全文大小：1145 K

文摘

A 77-year-old woman with a history of coronary artery bypass grafting 5 years earlier presented with anemia and was diagnosed with advanced gastric cancer involving the pylorus. Preoperative angiography revealed that the right gastroepiploic artery (RGEA) graft was patent. Multidetector-row computed tomography showed the running pattern of the RGEA graft and also revealed a vascular anomaly belonging to type V of Adachi's classification. Adachi's type V is a rare vascular anomaly in which the common hepatic artery originates from the superior mesenteric artery. The patient was treated successfully with a distal gastrectomy and removal of the D2 lymph node with preservation of the RGEA graft. Because of the difficulty in confirming the running pattern of the artery during the surgery, it is important to define the arterial running pattern preoperatively by using multidetector-row computed tomography, including 3-dimensional angiographic imaging.