Between 1978 and 1982, 1000 patients under consideration for peripheral vascular reconstruction underwent coronary angiography. Normal coronary arteries were found in 8%; mild to moderate coronary artery disease (CAD), in 32%; advanced but compensated CAD, in 29%; severe correctable CAD, in 25%; and inoperable CAD, in 6%. Severe correctable CAD was demonstrated in 14% of patients who had no indications of CAD on clinical criteria. Patients with severe correctable CAD were advised to undergo myocardial revascularization before the vascular operation. Under this protocol, a total of 1292 cardiac and peripheral vascular reconstructions were performed with an overall mortality rate of 2.6% (5.2% for myocardial revascularization and 2% for vascular operation). Only one death (0.8%) occurred after peripheral vascular reconstruction in 130 patients who had preliminary myocardial revascularization. These results indicate that approximately 30% of all patients who require vascular reconstruction have severe, but surgically correctable, CAD and that preliminary myocardial revascularization appears to add a margin of safety to the subsequent vascular operation.