We present a new technique for avoiding possible kinking or angulation of t
he sequential left internal mammary artery to left anterior descending arte
ry (LIMA-LAD) anastomoses when the LAD follows an intramuscular course. A 3
- to 5-mm cusp of saphenous vein segment is interposed between the intramus
cular LAD segment and internal mammary artery (IMA) at the sequential anast
omotic site, to which the distal portion of the IMA was anastomosed in stan
dard end-to-side fashion.