RESUMEN
It has been well established that the internal thoracic artery (ITA) is a good alternative to the saphenous vein as conduit for coronary artery bypass grafting because of superior early and late patency. Many surgeons now commonly use both ITAs for CABG and many have adopted complex grafting methods such as free ITA graft and sequential anastomosis; despite these techniques, it's not always possible to achieve complete revascularization with arterial conduits. More recently the right gastroepiploic artery (rGEA) and the inferior epigastric artery (IEA) have been used as alternative arterial conduits. The authors report the experience of a case of myocardial revascularization in a patient with angina not responsive to medical therapy, severe tri-vessel coronary artery disease, which had a previous total bilateral saphenectomy; the patient was also found to have a right fibrothorax. In the surgical strategy the authors considered that the bilateral use of mammary artery could have been the cause of the depressed respiratory function and that it was important to leave intact the left hemithorax; they therefore employed the rITA in the revascularization of the anterior descending (AD). To complete the revascularization they used the IEA for a marginal branch of the circumflex artery and the rGEA for the interventricular posterior artery, branch of the right coronary artery. In this fashion good early results were obtained with absence of perioperative complications with a good life expectancy.