 Hello everybody, I am Dr. Karthik Rathi, junior resident in the department of radio diagnosis at Katsurba Medical College, Manipal. The topic of my presentation is role of CT coronary ancho in evaluation of post-CABG or percutaneous intervention complications. A CABG graft is placed to increase blood flow to the myocardium in cases of coronary artery disease. Grafts, arterial or venous are either sutured or AV connector devices can be used. Arterial grafts have better patency rates than venous grafts. Screening of grafts for patency in the early, that is less than one month, as well as late, that is more than one month, post-operative periods are essential. Patency of grafts can be assessed either by catheter angiography or CT angiography. CT angiography is preferred over percutaneous angiography to assess graft patency, since it is minimally invasive and better tolerated. We present four cases of patients who underwent coronary angiopipers graft surgery who were later evaluated for complications of the same on presentation with chest pain or dyspnea. Retrospective ECG-gated CT coronary angiovas performed at our institution using Phillips incisive 128 slice CT with a prefix standard protocol. Acquisition, baller striking technique from cardiac base to thoracic inlet, that is lung apex with inclusion of the subclavian arteries performed in a cordial to cranial direction. Single breath hold at mean heart rate of 60 to 70 beats per minute. Non-ordinated contours material was injected through an 18 to 20 gauge cannula at the rate of 3 to 4 ml per second. Post-processing of phase obtained at 75% of the RR interval was reconstructed from which state and curve multiplanar reformations were reformatted and used for image interpretation. Other phases were also reconstructed from 10 to 100%. Axial CT images at 75% of the RR interval and curve planar post-process images were performed predominantly used for image interpretation. Complications can be further divided into early and late complications. Early complications from bosses it is the most common in early post-operative period. There can be graft malposition or kinking, grafts past itogenic complications such as pericardial infusion or pneumothorax, graft aneurysm, acute occlusion. Late complications can be graft aneurysm or chronic occlusion. Our first case was a patient who had a history of undergoing PCI stenting of proximal RCA in view of non-stemmy, presented 12 days later with complaints of breathlessness and orthopnea. CT coronary angio was advised. These are the pre and post contrast axial images of the CT coronary angio. A secular, lobulated contrast filled out pouching was noted arising from the segment 1 of RCA, proximal to the stent. A coronal and curve planar images of the same surrounding hematoma was seen which was suggestive of pseudo aneurysm with surrounding hematoma intending on the myocardium of right ventricle. These are the straight and 3-day reconstructed images of the same which confirmed the findings. Pseudoaneurysm was noted arising from proximal segment of RCA, just proximal to the stent. On follow up, check coronary angio showed multifacil disease with giant RCA coronary aneurysm. Patient was planned for emergency repair of giant coronary aneurysm. Our second case was unknown case of IHD status post coronary angio CABG who presented with retrosanal chest pain burning type 6 months post-op. These are the SVG2 obtuse marginal graft. This is SVG2 RCA and lima 2 layered graft. Lima 2 LED graft showed good contrast opacification and caliber. However, SVG2 OM and SVG2 RCA grafts showed proximal segment occlusion just distal to the origin. However, when maintained faint distal contrast opacification then SVG2 RCA there was narrowing at the anastomosis also. But faint contrast opacification was maintained. These are the straight axis views of the same confirming the findings. On follow up, patient was diagnosed as non-stemmy. CT coronary angio showed blocked SVG2 D1 graft. Coronary invasive angiogram showed native multi vessel disease. Patent lima 2 lad SVG2 RCA PDA osteoproximal narrowing was seen with diffuse small vessel occluded SVG2 D1 graft. Invisive angio was not able to visualize the SVG2 OM graft but it was patent on CT coronary angio. Patient improved with medical management. Our third case was a patient status post CABG2 check status of vessels who complained of chest pain. The SVG2 obtuse marginal that is FNO venous to obtuse marginal venous graft showed acute bend with mild kinking in the proximal most part. However, rest of the graft showed normal caliber with maintained contrast opacification. There was acute bending with kinking in the proximal most part. Our last case was a patient who underwent CABG for ischemic heart disease two years back presented with generalized weakness since one month. Tessnion exertion, pedal edema and facial puffiness since one week. The SVG2 LAD graft was patent and showed good contrast opacification. SVG2 RCA graft was also patent showed few areas of kinking. However, normal contrast opacification but as LCX graft showed no contrast opacification. On 3D images also these grafts were seen. On follow-up coronary angio shot triple vessel disease with blocked LCX graft which was not visualized on coronary and CT coronary angio. And the patient was planned for medical management and improved with medical management. Coming to the results out of our four patients who had complications on CT coronary angio all underwent invasive coronary angio and findings were confirmed. SVG2 OM graft which could not be assessed on invasive coronary angio while could be assessed on CT coronary. Mildly attenuated grafts seen on CT coronary angio appeared normal on invasive angio. One patient who underwent repair of coronary and aneurysms while other were managed conservatively. Summarizing various pathologies affecting coronary artery stents and grafts can be evaluated optimally using CT coronary angio. The knowledge and the of the anatomy and proper planning of the scan are essential for complete evaluation of the coronary arteries and grafts. Various pathologies affecting it can be evaluated optimally by CT coronary angiography. These are my references. Thank you.