SVG-RCA Angiogram: Complex Bypass Graft Anatomy

By Vincent Varghese, DO, and Jon C. George, MD, Division of Interven-tional Cardiology and Endovascular Medicine, Deborah Heart and Lung Center, Browns Mills, New Jersey

Deciphering complex coronary anatomy can be challenging, particularly in post-CABG patients. CABG surgery using conduits with multiple distal anastomoses has the potential to lead to graft failure, largely related to bypass graft flow dynamics. Recognizing conventional, as well as anomalous, coronary artery patterns in specific angiographic views is paramount in understand-ing elaborate graft anatomies. We present herein an interesting case of complex bypass graft angiography with multiple anastamoses supplying the entire myocardium.   

Video 3. Selective saphenous vein graft to right coronary artery (SVG-RCA) angiogram demonstrating patent graft with side to end anastomosis to the RV marginal artery, and distal right posterolateral artery. End to end vein graft limb from mid SVG-RCA to the left posterior descending artery (LPDA). SVG-LPDA originates from Left internal mammary artery to Left anterior descending artery graft (LIMA-LAD), which is widely patent. 

Related article: Complex Bypass Graft Anatomy: Deciphering the Puzzle