LIMA/BIMA Grafting in Bypass Surgery – Why the Graft You Choose Changes Everything

If you’re being told you need bypass surgery in Ahmedabad — or anywhere in Gujarat — there is one question that most patients never think to ask, and that most hospitals never voluntarily answer: what will my bypass grafts actually be made from? 

The answer matters more than almost any other technical decision in your operation. LIMA and BIMA grafting — using your own internal mammary arteries as bypass conduits rather than a vein from the leg — produces results that are dramatically better over a 10 to 20 year horizon. 

At EPIC Multispecialty Hospital in Ahmedabad, arterial grafting is our standard, not our exception. Here’s why that should matter to you. 

What Are LIMA and BIMA Grafts — and Why Do They Perform Better?

• LIMA — Left Internal Mammary Artery: Runs along the inside of the left chest wall. When used to bypass the left anterior descending artery — the most critical coronary vessel — LIMA graft patency exceeds 95% at 10 years. Nothing else comes close. The LIMA-to-LAD anastomosis is considered the single most important technical achievement in bypass surgery. 

• BIMA — Bilateral Internal Mammary Artery: Using both internal mammary arteries provides a second arterial conduit for additional bypass targets. Studies consistently show that BIMA grafting reduces the need for repeat revascularisation and improves long-term survival — particularly in patients under 65 to 70 years of age. 

• Why vein grafts fail: Saphenous vein grafts are effective in the first few years but undergo accelerated atherosclerosis. Within 10 years, 40 to 50 percent of vein grafts may have significant disease. Patients return with chest pain, find their vein grafts are blocked, and face repeat intervention. Arterial grafts avoid this trajectory. 

• Radial artery grafting: The radial artery from the wrist is a third arterial conduit option, typically used as a supplementary graft alongside LIMA or BIMA. It performs better than vein in most anatomically suitable cases. 

• Full arterial revascularisation: Using only arterial grafts for all bypass targets — no vein at all — is achievable in selected patients and represents the pinnacle of bypass surgery technique. Our surgeons aim for this wherever anatomy and patient factors allow. 

Who Is Suited to BIMA Grafting — and the Honest Trade-Off

BIMA grafting is not appropriate for every bypass patient, and being honest about that is important. 

The main additional risk with bilateral mammary artery harvesting is sternal wound healing. When both internal mammary arteries are taken from the chest wall, blood supply to the sternum is reduced. In patients with diabetes, obesity, or poor tissue perfusion, this increases the risk of deep sternal wound infection — a serious complication that can derail an otherwise successful operation. 

For this reason, BIMA grafting is generally reserved for non-diabetic or well-controlled diabetic patients who are not significantly obese, are under 70 years of age, and are having elective rather than emergency surgery. The younger and fitter the patient, the more the long-term benefit of BIMA outweighs this additional risk. 

For patients who don’t meet those criteria — for whom BIMA risk is genuinely elevated — LIMA plus vein graft, or LIMA plus radial artery, remains an excellent approach. What matters is that the decision is made deliberately, with the patient’s specific profile in mind, not reflexively defaulting to vein grafts because they’re quicker to harvest. 

At EPIC Hospital in Ahmedabad, our surgeons discuss graft strategy with every bypass patient before the operation. You should know exactly what will be used and why. 

Questions About Arterial Grafting in Bypass Surgery

Is LIMA/BIMA grafting available as standard at EPIC Hospital in Ahmedabad? 

Yes. Arterial grafting — LIMA as minimum, BIMA where appropriate — is our standard approach for bypass surgery. We don’t default to vein grafts unless there’s a specific clinical reason to do so. 

Does BIMA grafting make the operation more complicated or risky? 

It adds approximately 20 to 30 minutes to the operative time and carries the sternal healing consideration described above. In appropriately selected patients, the operative risk is not meaningfully higher — and the long-term benefit is significant. In patients who aren’t good candidates for BIMA, we don’t push it. 

Will I need an angiogram after bypass surgery to check if the grafts are working? 

Not routinely. Most post-bypass follow-up uses non-invasive testing — stress testing or CT angiography — to assess graft function if symptoms return. A formal catheter angiogram is reserved for patients with symptoms or findings that suggest a problem with graft patency. 

What happens to the wrist if a radial artery graft is used? 

Before using the radial artery, we perform an Allen’s test to confirm that the hand has adequate alternative blood supply through the ulnar artery. If the test is satisfactory, the radial artery can be safely harvested with no significant long-term impact on hand function.

Ask About Your Graft Strategy — It Matters More Than Most Patients Know

LIMA and BIMA grafting in bypass surgery is not a niche technical detail. It’s the difference between a bypass that lasts and one that needs redoing in 10 years. At EPIC Multispecialty Hospital in Ahmedabad, we choose the best graft for each patient — and we explain the reasoning. 

Book a consultation with our bypass surgery team online, call us today, WhatsApp your coronary angiography for a graft strategy review, or visit EPIC Hospital in Ahmedabad — and have a proper conversation about the surgery you actually need.