©2009 The Editorial Committee of Annals of Thoracic and

Coronary artery disease (CAD) coexists in 40 % of cases with abdominal aortic aneurysm (AAA). Previous reports have demonstrated the progression of myocardial ischemia after AAA repair and an increased rate of AAA rupture after coronary artery bypass grafting (CABG). We herein describe the case of a 63-year-old man who underwent CABG combined with AAA repair to prevent perioperative cardiovascular events. Computed tomography revealed an AAA 49 mm in diameter. Coronary angiography demonstrated single-vessel CAD localized to the right coronary artery. The patient underwent percutaneous coronary intervention before aortic surgery. On follow-up coronary angiography, restenosis was detected in the stent. In a second strategy, AAA repair was combined with CABG and per-formed with the aim of preventing cardiovascular events. A short laparotomy was performed, and an off-pump CABG was performed using the in situ right gastroepiploic artery via a transdiaphragmatic approach without sternotomy. The small abdominal incision provided stability of the surgical retractor sufficient for fixing a heart-stabilizing device. Furthermore, a surgical retractor was used in an inverted V position to ensure sufficient space for the surgery. We conclude that a one-stage operation comprising CABG and AAA repair and using a transdiaphragmatic approach is a safe and reasonable operative proce-dure. (Ann Thorac Cardiovasc Surg 2009; 15: 354–357) Key words: transdiaphragmatic approach, coronary artery disease, abdominal aortic aneurys