Several alternative techniques in coronary artery bypass grafting (CABG) have been developed to reduce high-risk patients postoperative morbidity and mortality (1-92). The use of pedicled arterial grafts have demonstrated to be safe and effective procedures in patients with atheromatous aorta, porcelain aorta, poor quality saphenous vein, complicated anatomy of the coronary artery disease (CAD), left ventricular dysfunction, redo CABG, concomitant lower extremities revascularization and elderly patients in which all those situations are associated (1-8, 10-92). Despite of the introduction of these new technical alternatives for the surgical management of this group of patients, the challenge still persists. This report describes our initial experience with this approach.