OBJECTIVE: In the last decade, the coronary artery bypass grafts (CABG) with arterial grafting had been remarkable, mainly the combined ones in Y or T form, which start from the left internal thoracic artery (LITA). Elaborating this kind of grafting, we identified a certain worry related to the anastomoses of the radial artery in LITA, principally when realized in T, since any small traction, angulations or spasms of the radial artery might impaired the flow of the distal anastomoses of LITA to the anterior interventricular artery. METHOD: We modified the combined graft technique, by making anastomoses of the radial artery to the anterior interventricular artery, and, consequently the LITA is sewed above the anastomoses of the radial artery to the anterior interventricular artery, favoring therefore, the revascularization of the anterior interventricular artery with the LITA, transforming the radial artery into almost an extension of the LITA to the remaining branches of the left coronary artery. CONCLUSIONS: This technical modification for these composite grafts is simple, safer and effective, and it will enable a larger number of surgeons to routinelyuse composite grafts in coronary artery bypass grafting
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