We report a case of co-existent coronary and peripheral vascular disease with collaterals to the lower extremities in a 72-year-old female. The patient had triple-vessel coronary artery disease, an occlusion of the bilateral iliac arteries, and the left internal mammary-inferior epigastric artery collateral pathway was a major route to the lower extremities. Coronary artery bypass grafting and right axillo-bifemoral bypass were performed. The well-developed left inferior epigastric artery was used as a conduit to the circumflex artery.