Total Arterial Bypass or Total Arterial Revascularization is a modern surgical method that need advanced knowledge of procedure, complexities, and technique. It is an esoteric procedure that uses IMA as a conduit of CABG. For total arterial grafting in CABG, the usual conduits that are used are the bilateral Internal Mammary Arteries i.e. LIMA and RIMA. Traditionally in the surgery, LIMA is used as a
pedicle graft and the free RIMA on it makes the LIMA – RIMA ‘Y’ composite grafting. The LIMA stem is used to graft the LAD and Diagonal branches; whereas the RIMA stem is used to graft the OMS, PLB and PDA branches. In certain situations where the Pedicle LIMA cannot be used for e.g. in case of left Subclavian Artery stenosis, we can still do total arterial grafting by making certain modifications. Instead of pedicle LIMA, RIMA pedicle to be used and the free LIMA onto it making the RIMA – LIMA ‘Y’ composite grafting. In this case the RIMA stem is used to graft the LAD and the LIMA stem is used to graft the Diagonal, OMs, PLB and PDA branches. This makes arterial grafting complete.