BACKGROUND Internal mammary artery (IMA) grafts provide equal or superior graft patency compared to other conduits. The IMA length limits extensive myocardial revascularisation with IMA grafts alone. This study aimed to determine the results of lengthening free IMAs with a short proximal segment of saphenous vein (SV) to enable more extensive myocardial revascularisation. METHODS Patients (n=92) who underwent end-to-end composite SV-IMA grafts were followed up through cardiology and death register databases. RESULTS The mean patient age was 57.5 years and median follow up 10.9 years. There was no perioperative mortality and 10-year survival was 89.6%. Thirty-one patients (34%) underwent repeat angiography at a median of 2.8 years postoperatively. The 10-year freedom from angiography showing SV segment occlusion was 89% with a median time to angiography of 2.3 years (nine patients). The number of distal anastomoses was the only independent predictor of SV segment occlusion HR per anastomosis=0.26 (p=0.01). In five sequential grafts to the circumflex and right coronary systems, the IMA portion of the graft remained patent following SV segment occlusion. CONCLUSIONS Graft patency is improved by a greater number of coronary artery anastomoses.