"All-arterial" bypass surgery

Because of the outstanding patency rates of arterial bypass grafts (see above), the two thoracic arteries (left internal mammary artery/LIMA and right internal mammary artery/RIMA) together with the radial artery from the arm for high-grade stenoses) are used as bypass grafts in our clinic, especially in patients below the age of 70 years, in order to spare the patient a second operation at an advanced age. This is often required after 10 to 15 years in patients with mainly vein bypass grafts because of further graft stenosis (though these can be dilated) and blocked grafts. In order to be able to join all coronary arteries to arteries, Y grafts or T-grafts with branching of the arterial bypass grafts similar to the human coronary system are also used (see illustration). This achieves a markedly improved long-term prognosis as regards the patency of the bypasses.