Retrograde wiring: A novel technique for identifying the origin of unusual saphenous vein grafts

Background: In the absence of radiopaque graft markers, engaging unusual saphenous vein grafts can be challenging. Methods: We describe a case in which a saphenous vein graft to the first obtuse marginal branch could not be located, in spite of performing aortic root angiography. The saphenous vein graft was wired retrogradely through the native left main and the wire was advanced into the aorta, serving as a marker of the abnormally low origin of the graft that was successfully engaged with a multipurpose catheter. Results: The guidewire was successfully advanced retrogradely through the SVG into the aorta, allowing localization of the SVG ostium that was sewn in an unusually low location. Conclusions: Retrograde SVG wiring is an advanced, "last resort" technique for identifying the ostium and cannulating unusual aortocoronary bypass grafts.