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In an attempt to simulate the longevity of IMA grafts and overcome the problem of reaching the distal RCA, the gastroepiploic artery (GEA) is sometimes used as an in situ graft to the posterior or inferior surface of the heart (RCA, posterior descending artery, posterior left ventricular) [3]. The GEA can be cannulated using catheters designed for abdominal vascular intervention such as Cobra or Simmons catheters [4]. The celiac trunk is accessed from the abdominal aorta in the direction of the common hepatic artery (the other branch being the splenic artery) (Figure 5.4). The gastroduodenal artery arises in an inferior direction and gives off the pancreatico‐duodenal branch beyond which it becomes the GEA, which passes through the diaphragm to reach the inferior wall of the heart (Figure 5.4). Anastomotic stenoses are not rare and may require percutaneous treatment [5].

Figure 5.4 Vascular anatomy of a pedicle graft of the right gastroepiploic artery to right coronary artery.