Technique of sequential grafting the left internal mammary artery (LIMA) to the circumflex coronary system.

The most common grafting technique performed with the IMA's is to anastomose the LIMA to the Left Anterior Descending (LAD) coronary system. With the expanded use of this conduit, the Right IMA (RIMA) can be used to graft the LAD system and the LIMA can be routed to the Circumflex (Cx) coronary system. This is the most common graft design in case of coronary disease affecting the LAD and the circumflex systems. The technique used at the Medical Center "The Klokkenberg" since 1989 to route the LIMA to the marginal arteries through a pericardial window is described in detail.