Axillary-coronary artery bypass using a vein graft via the suprasternal route

Redo coronary artery bypass grafting after an in-situ right internal thoracic artery graft to the left anterior descending artery is challenging. For such a 52-year-old male patient with a history of mediastinitis, we performed redo bypass grafting of the right coronary artery using a saphenous vein graft and xiphoid resection via the suprasternal route with the left axillary artery as the inflow source and the graft were patent. The axillary artery is an inflow source for patients with inaccessible aorta. Combining the suprasternal route with a xiphoid resection provides a bail-out option.