Harvest of the internal thoracic artery (ITA) in patients with aortoocclusive disease carries a risk of leg ischemia. Staged revascularization of the lower extremities and coronary artery in patients with aortoiliac occlusive disease with collateral vessels to the lower extremities via the ITA is reported. Revascularization of the aortoiliac occlusion prior to coronary artery bypass grafting can be performed in stable patients with appropriate perioperative coronary precautions. In patients with unstable angina and aortoiliac occlusion with collateral vessels to the leg via the ITA, coronary artery bypass grafting should be performed without using the ITA.
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