Aortic root angiogram showing saphenous vein graft

Aortic root angiogram showing saphenous vein graft in LAO view

Aortic root angiogram showing saphenous vein graft in LAO view
Aortic root angiogram showing saphenous vein graft in LAO view

Aortic root angiogram showing saphenous vein graft arising from the anterior aspect of the aorta and joining the LAD territory. Three aortic sinuses of Valsalva are also seen at the proximal end of the aortic root. Right coronary artery is seen arising from the right sinus and has a tight proximal lesion.

Distally the RCA is totally occluded beyond the right ventricular branches, but that it not clear in this image. It had already been delineated in a selective right coronary angiogram. Metallic sternal suture wires are seen anterior to the aorta, indicating previous sternotomy closure.

Aortic root angiogram for visualization of saphenous vein grafts is done when attempts at selective cannulation of saphenous vein grafts fail. It is always worthwhile to check the operative notes to know the position of saphenous vein grafts before attempting cannulation as the diagrams often guide us in cannulation. If the diagrams are not available, blind probing at the usual sites of SVG to aorta attachment is done.

Very often cannulation of SVG by this technique is feasible. It is needless to say that direct injection into the SVG gives better visualization than an aortic root angiogram, at a lesser volume of angiographic contrast agent. Most cardiothoracic surgeons use saphenous vein grafts for right coronary and left circumflex territory and left internal mammary artery for the left anterior descending artery.