Dr Kshitij Dubey

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Total Arterial Bypass Surgery Lima-Rima-y

For total arterial grafting in CABG, the usual conduits used are the bilateral Internal Mammary Arteries i.e. LIMA and RIMA. Usually, LIMA is used as a pedicle graft and the free RIMA on it to make the LIMA – RIMA ‘Y’ composite grafting.

About Lima Rima Y

Coronary Bypass Graft Surgery entails a surgeon to use a healthy blood vessel from another part of your body to create an alternate route, bypass, around narrowed or blocked section of your coronary artery, to allow more blood to reach heart vessels.


The surgery will be performed by making cut through your breastbone and spreading apart your rib cage, the technique is called sternotomy. Once the rib cage is open and expose the internal organ within the chest cavity, the surgeon next cuts through the sac-like lining that protects the heart to access the heart itself. The coronary arteries lie on the front side and the back surfaces of the heart. The process of harvesting a vein to use as a graft vessel starts.

The surgeon removes a piece of healthy blood vessel

  • Leg (Saphenous Vein)
  • Forearm (Radial Artery)
  • Underneath the chest wall

What is Lima Rima Y?

When the bypass is done using the chest wall artery for graft vessel, the approach is that of Lima Rima Y or Rima Lima Y. These other vessels are used to bypass graft. They are one of the closest available arteries to the heart and coronary arteries. The left and right internal mammary arteries that is Lima and Rima respectively are highly favoured by the doctors, because of the high potency rate for a long time.

The Advantages of using the chest wall arteries

The two major advantages you get by this surgical procedure are:

  • Mammary Arteries are attached to main artery, this mean that only its other end must be disconnected and grafted onto the diseased coronary artery. This gives advantage of natural inflow.
  • They are arteries and thus Lima and Rima are most accustomed to forceful blood flow than saphenous vein. Veins carry blood from the body back to the heart, and aren’t under much pressure. This gives you a long-term advantage and higher durability.
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