Internal mammary arteries as major blood supply to lower limb in coronary artery disease with peripheral vascular disease.

We describe a case of severe peripheral vascular disease in a patient presenting for coronary artery bypass grafting (CABG). There was an occlusion of the abdominal aorta with collaterals from the internal mammary arteries (IMA) and inferior epigastric arteries (IEA) supplying the lower limb. Off-pump CABG was carried out without harvesting the IMA. In presence of concomitant severe peripheral vascular disease, lower limb blood flow should be evaluated with Doppler ultrasound, and in selected cases, computed tomography angiogram should be performed to rule out IMA-IEA collaterals dependent limb perfusion.