Complete myocardial revascularization with arterial grafts without using the mammary artery

We report on the case of a 60-year-old male patient who developed a crescendo angina 9 years after a coronary artery bypass procedure. Coronary angiography revealed triple vessel disease. None of the internal mammary arteries were available and the saphenous veins had previously been stripped. A complete myocardial revascularization by means of arterial grafts was still achieved by using both the epigastric arteries, and an in situ right gastroepiploic artery.