Alternative conduits for aortocoronary bypass grafting

The internal mammary artery is the premier conduit for initial and repeat coronary artery bypass grafting and should be used as either a pedicled or free graft whenever possible. Saphenous veins from the greater and lesser systems are distinctly second choices but can serve satisfactorily as aortocoronary grafts for many years. When neither the internal mammary arteries nor the saphenous veins are available, the cardiac surgeon today must choose from a wide variety of alternative conduits that have been used periodically over the past two decades for coronary artery bypass grafting.