A route for venous or free arterial conduits to the distal circumflex artery branches in coronary artery bypass operations

We describe a route for venous or free arterial conduits to the distal circumflex artery branches in coronary artery bypass operations. After constructing the distal anastomosis, open the space behind the inferior vena cava and pass the conduit through, in front of the right pulmonary vein to be anastomosed to the right side of the ascending aorta, anterior to the superior vena cava. This generates a lie of the conduit which allows it to sit in line with the target vessel (Fig. 1). Care must be taken to avoid conduit rotation as it passes behind the inferior vena cava.