Cardiac catheterization was performed in a prospective series of 1000 patients under consideration for elective peripheral vascular reconstruction from 1978-1982. Of these, 381 (mean age 62) presented primarily because of lower extremity ischemia. Severe, surgically correctable coronary artery disease (CAD) was documented in 79 (21%) of the leg group, and 68 (18%) received myocardial revascularization, with three fatal complications (4.4%). In this subset, 39 patients have had uneventful aortoiliac, femoropopliteal or distal extremity procedures, compared to an operative mortality of 23% for 13 others with uncorrected or inoperable CAD (p = 0.015). A total of 286 patients have undergone 407 peripheral vascular operations with eight early deaths (2.8%). An additional 114 patients (30%) died during the late follow-up interval, including 48 (13%) with cardiac events. Both the cumulative 5-year survival (72%) and cardiac mortality (16%) after coronary bypass are superior to comparable figures (21% and 56%, respectively) among 36 other patients with severe, uncorrected or inoperable CAD (p = 0.0001). Five-year survival appears to be improved by myocardial revascularization in men (p = 0.0027), hypertensives (p = 0.0001), nondiabetics (p = 0.0002) and those over 60 years of age (p = 0.0072).