Bifurcating saphenous vein and left internal thoracic graft anatomy: Treatment of a left main equivalent saphenous interposition vein graft lesion and virtual histology/grey scale IVUS characterization post-intervention

Saphenous vein graft interventions carry a significant risk of adverse events. We present a case in which a free left internal thoracic artery (LITA to the LAD) had been anastomosed to a saphenous vein graft (SVG) to an obtuse marginal (OM) as its proximal anastomosis. Due to surgical iatrogenic injury during a subsequent aortic valve replacement, the proximal portion of this dual graft was resected in error and then repaired using an interposed vein graft (vein patch). We present the first known case of percutaneous intervention to an interposition vein graft stenosis with left main equivalent anatomy. Virtual histology (VH™) and grey scale intravascular ultrasound (IVUS) were utilized to visualize plaque characteristics in this novel lesion.