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We report an 81-year-old man with coronary artery disease and bypass surgery with a sequential internal mammary artery (IMA) to the diagonal and then the anterior descending, who developed regional variations in the flow through his arterial conduit. Four years after his initial surgery, he developed atresia of the proximal segment of the arterial conduit due to competitive flow. After reoperation, the patient reconstituted flow in his proximal segment, but developed atresia of the distal segment. We describe for the first time, regional variation in arterial conduit patency and discuss factors controlling patency in the sequential arterial conduit.