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CASE PRESENTATION This is the case of a 69-year-old man with a past medical history of sleep apnea syndrome, and chronic lower limb ischemia syndrome grade IIB. Smoking habit was among the patient’s cardiovascular risk factors reported until 2016, followed by arterial hypertension, type II diabetes mellitus, and dyslipidemia on medical therapy. Back in January 2017, the patient was hospitalized due to second-degree atrioventricular block with implantation of a DDDR pacemaker. During hospitalization complete arrhythmia due to atrial fibrillation was confirmed that was eventually anticoagulated with rivaroxaban. In June 2017 the patient developed unstable angina with a diagnosis of severe aortic stenosis with left main coronary artery disease and 3-vessel disease. Surgical aortic valve replacement followed by revascularization with double left internal mammary artery bypass towards the left anterior descending coronary artery, and saphenous vein graft towards the second obtuse marginal branch was decided. Currently, he complaints of angina-like symptoms during minimal exertion with a 5 to 6-month evolution, which is why cardiac catheterization was performed (prior to the procedure, the patient’s informed consent was obtained anticipating the possible publication of the case for teaching purposes). This study was performed via femoral access after discarding the arm that presented some issues. It showed...