Activate Shilgengar by sacrificing Lesser Masticore.
When Lesser Masticore dies, its persist ability triggers, returning it from your graveyard to the battlefield without a -1/-1 counter on it due to Vizier of Remedies.
Resolve the Shilgengar ability
Repeat.
This elegant loop turns the tragedy of endless sacrifice into an overflowing reservoir of resources. By leveraging Shilgengar, Sire of Famine to repeatedly sacrifice Lesser Masticore, you trigger the latter's persist ability to bring it right back to the battlefield. The presence of Vizier of Remedies completely neuters the -1/-1 counter that would normally cripple Lesser Masticore's return, allowing the cycle to repeat indefinitely and fueling Shilgengar's first ability to continuously churn out infinite Blood tokens.