Coronary artery disease (CAD) is associated with abdominal aortic aneurysm in greater than 60% of cases. CAD continues to affect postoperative complication rates. Half of the deaths that follow resection of abdominal aortic aneurysms are due to perioperative myocardial infarctions. On evaluation for surgical resection of an abdominal aortic aneurysm, six patients were found to have significant CAD. Each underwent coronary artery bypass surgery prior to elective resection of the aneurysm. No deaths or myocardial infarctions occurred following any of the procedures. We restrict our indications for coronary angiography to the evaluation of patients with unstable angina (pain at rest or after minimal exertion) in whom noninvasive studies reveal evidence of CAD, and for patients who are unresponsive to medical management.