Internal mammary artery-saphenous vein composite conduit: an alternative for the proximal coronary anastomosis.

A patient who had previously undergone saphenous vein bypass grafting was seen with recurrent angina requiring reoperation. At the second operation, technical problems with the ascending aorta ultimately excluded its use for the proximal anastomosis for the second of two bypass grafts. Anastomosis of the left internal mammary artery to the proximal end of the saphenous vein graft successfully resolved the problem.