Controversy persists as regards the efficacy of aortocoronary saphenous vein bypass graft (SVBG) compared to direct internal mammary artery (IMA) anastomosis. In general, the IMA graft (IMAG) is considered to be superior as regards postoperative patency. To avoid preselection bias, 74 consecutive, unselected patients with bypassable lesions of the left anterior descending artery (LAD) were randomized to undergo either SVBG or IMAG to the LAD in 1972-1974. The majority of patients had, in addition, SVBGs to other vessels. Postoperative angiograms, an average of 6 months after surgery, were obtained in two-thirds of the patients. The following observations were made: (formula: see text). In this series there is no clear advantage of the IMAG over the SVBG. The preparation of the internal mammary artery for grafting is tedious and the anastomosis more difficult to perform. The resultant flow in the internal mammary artery graft is less overall than in the SVBG. In over 400 unselected SVBGs to the LAD that have been restudied thus far in our practice, an 86% patency rate has been achieved.