The inferior epigastric artery (IEA) is a new arterial graft for myocardial revascularization. We examined the inferior epigastric artery, the internal thoracic artery (ITA) and representative sections of the coronary arteries in 45 postmortem examinations, for microscopic signs of atherosclerosis. In addition, a morphometric evaluation of the intima and media of both conduits was performed. The intima of the ITA is significantly thicker, but atherosclerosis is absent. There are fewer fenestrations/mm in the internal elastic lamina (IEL) (4.00 +/- 1.60 versus 4.62 +/- 1.46) of the IEA and the combined thickness of media and intima is lower (0.20 +/- 0.04 mm versus 0.30 +/- 0.06 mm). However, 24% of IEAs showed medial calcification of variable degrees. We conclude that the IEA should not be used routinely for myocardial revascularization until the long-term patency of this graft has been explored.