**7. Conclusion**

Experience regarding the preference of use of bilateral internal mammary arteries as grafts is growing big. However, despite the fact that the evidences are compelling, the absence of prospective randomization makes them vulnerable to ctriticism.

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The use of bilateral internal mammary arteries can be conducted safely. It can offer long-term symptomatic improvement and also improve survival. Surprisingly, multiple arterial conduits are used in <15% of patients undergoing a CABG, and the radial artery is the most common choice for the second arterial conduit.

The lack of robust protocols for using BITA grafting, contributes to the variations in practises amongst surgeons. Quidelines for BIMA usage, including variables such as age, the type of diabetes, obesity, LV function and the suitability of the coronary anatomy would emergence in the future. More specifically a possible scoring system taking into consideration Syntax score and EuroSCORE maybe able to become a quide for BIMA utilization and that may overcome the difficulty for surgeons to extend the use of BIMA.
