OBJECTIVE Coronary artery and aortoiliac disease frequently coexist. In rare instances simultaneous procedures may be required. This study reports our experience with ascending aorta to bifemoral bypass. METHODS Prospective consecutive sample study. METHODS Ten male patients who underwent concomitant aortoiliac and coronary revascularization with the ascending aorta as the source of inflow to the femoral arteries between 1989 and 1991. RESULTS One hospital death was unrelated to the surgical technique. All survivors displayed an uneventful recovery and were free of symptoms. Follow-up was obtained in all nine cases, they all stayed asymptomatic in terms of coronary artery disease and peripheral vascular disease. Echo-doppler studies showed perfect patency of the aorto-femoral grafts in all cases. CONCLUSIONS This study shows that the ascending aorta to bifemoral bypass constitutes an interesting alternative in selected cases mainly those with severe ischemia coronary and leg ischemia. It offers the following advantages: (1) it is easy to perform, (2) does not require an intraperitoneal procedure, (3) the graft's position behind the muscles of the abdominal wall is not compressible, (4) the ascending aorta is the source of inflow, and (5) it allows a shorter duration of hospital stay.