Coronary artery bypass surgery is one of the most effective ways to treat coronary heart disease. The bridge vessel material used to perform the bypass surgery is usually either its own vein or artery. Venous bridges involve the use of the patient’s own saphenous vein, for example, as the bypass material, while arterial bridges use the internal mammary artery, radial artery, and gastroretinal artery. In the selection of graft vessels, a venous bridge alone or a combination of arteries and veins is usually used. As the name implies, “total arterial bypass” means that all arteries are used as bypass vessels. What are the benefits of total arterial bypass? The saphenous vein is most often used as the graft material for bypass. This is because the saphenous vein is easy to obtain, has sufficient length, has a large caliber, and is easy to anastomose. However, after surgery, over time, the vein’s lining becomes diseased and the lumen narrows, which affects the outcome of the procedure. According to the statistics of large foreign heart centers, the patency rate of the saphenous vein is 75% at 5 years and 40% at 10 years. The left internal mammary artery is the most commonly used arterial bypass vessel, with a patency rate of 98% at 1 year and about 95% at 10 years after bypass surgery. Therefore, the advantages and disadvantages of using arterial versus venous bypass are obvious. In addition, other commonly used graft arteries, such as the right internal mammary artery, radial artery, and gastroretinal artery, also have good long-term patency rates. Therefore, the use of as many arteries as possible as bypass materials in coronary artery bypass surgery is the key to ensure the long-term results of the procedure, and the ability to achieve total arterial bypass is the most perfect procedure among them. Is every patient with coronary artery disease suitable for total arterial bypass surgery? Total arterialized bypass surgery, because it uses the artery as the graft vessel, has good long-term results, reduces the reoperation rate of patients and greatly improves their quality of life, so it should be used whenever possible. However, because each patient has their own special circumstances, for example, patients over 75 years old, or insulin-dependent diabetic patients, if bilateral internal mammary artery bypass is used, postoperative sternal healing will be somewhat affected; in some patients, the arteries available for bypass will be greatly limited due to various reasons such as trauma or previous surgery; “total arterialization “total arterialization” also requires a high level of surgical technique and corresponding equipment. Therefore, the ability to achieve total arterialization is affected by both the patient’s own condition and the medical condition. Is “total arterialization” more risky? No. Although total arterial bypass surgery is more difficult than traditional saphenous vein bypass surgery, the procedure itself does not increase mortality or complications. In addition, it greatly improves the long-term patency of the graft and reduces the incidence of perioperative infarction, resulting in a lower overall surgical risk.