Axillary artery-to-coronary artery bypass using a saphenous vein graft provides a simple and safe method of applying a minimally invasive coronary bypass grafting procedure when the internal thoracic artery is not an adequate conduit. Although this may allow use of aminimally invasive coronary bypass procedure, the patency of this technique is unknown. The purpose of this study was to review our experience in the clinical results and problems with left axillary artery to left anterior descending coronary artery bypass. Since 1999 we have applied this procedure in 5 patients (with a mean age of 72.6 years). All patients were high-risk candidates because of cerebral infarction, depressed renal function, previous heart operation, or previous surgical treatment of esophageal carcinoma. The saphenous vein was anastomosed to the left axillary artery, where it entered the thorax and continued to the left anterior descending coronary artery. The mean operation time was 3.1h (range: 2.3 to 4.7h). Angiography or thallium studies or Doppler echocardiography were performed to confirm graft patency. Postoperative angiography showed all grafts to be patent. All patients were discharged. During a mean follow-up period of 10.4 months, one patient in whom graft distributed over the subclavian vein died due to failure of the graft 6 months after the operation. Four patients were free from cardiac events. Axillary artery-to-coronary artery bypass using the saphenous vein is an effective and safe technique for high-risk patients if we pay attention to the course of the graft. In an effort to evaluate flow characteristics of the saphenous vein grafts (SVG) after the operation, we used transcutaneous ultrasound study with Doppler flow velocimetry of SVG. The diameter of the vessel, systolic peak velocity, diastolic peak velocity, and velocity ratio were recorded. Use of this may allow noninvasive identification of the bypassing grafts and comparison of their postoperative blood flow waveforms in patients following minimally invasive direct coronary artery bypass (MIDCAB). It can also be performed repeatedly to monitor the patient's clinical course after surgery.