The excellent results with the internal thoracic artery for coronary artery bypass grafting have prompted the search for other arterial conduits. From November 1991 to February 1992, 18 patients underwent coronary artery bypass grafting with the use of inferior epigastric artery grafts. Patients' ages averaged 52 +/- 9 years. Bilateral internal thoracic artery grafts were used in 17 patients (17/18, 94%) and a free graft with one inferior epigastric artery was used in each patient. The inferior epigastric artery grafts were anastomosed to the right coronary artery (n = 9), a marginal circumflex artery (n = 4), and to a diagonal artery (n = 5). Three patients had abdominal wound complication related to harvesting of the inferior epigastric artery. Immediate postoperative angiographic evaluation of inferior epigastric artery grafts showed that eight grafts were patent (8/14, 57%). Four of the occluded inferior epigastric arteries were grafted to the right coronary artery and one to the second marginal circumflex coronary artery. Because of the low patency rate of inferior epigastric artery grafts, a word of caution is necessary in the selection of patients. At the present time, the inferior epigastric artery appears to be an interesting alternative only in patients who have no other available conduits.