A patient presented with an enlarging aneurysm in a saphenous vein graft to the right coronary artery. The plan was to attempt recanalization of the native coronary CTO. However, the RCA could not be engaged due to extreme iliac tortuosity and calcification. The SVG was eventually engaged using a diagnostic multipurpose catheter that was exchanged for a guide catheter, but a primary retrograde crossing attempt failed. The patient returned and underwent placement of a Viabahn VBX covered stent to the SVG aneurysm via left radial cutdown with successful sealing of the aneurysm.
