Anesthesia for pancreatoduodenectomy in a patient with history of coronary artery bypass graft surgery: determination of optimal surgical management by the graft clamping test

We report a case of a 72-year-old man undergoing pancreatoduodenectomy, who had a history of coronary artery bypass graft surgery using the right gastroepiploic artery. We intraoperatively used the graft clamping test, which was assessed via electrocardiography and transesophageal echocardiography, to verify patency of the right gastroepiploic artery graft. Because the graft clamping test was positive, first, we interposed the saphenous vein graft between the splenic artery and right coronary artery. The abdominal surgery was then successfully performed without any cardiac complications. In such a complicated case, anesthesiologists who are responsible for assessment of the graft clamping test play a crucial role in determining the optimal surgical procedure.