A 69-year-old woman presented with symptoms of resting pain in the lower limb bilaterally. A computed tomography( CT) scan revealed occlusion of the infrarenal aorta and bilateral common iliac arteries, indicating Leriche syndrome. A coronary angiogram demonstrated in-stent restenosis in the left anterior descending coronary artery. Therefore, the patient underwent off-pump coronary artery bypass grafting (left mammary artery to left anterior descending coronary artery) and ascending aorta-bifemoral bypass using the HeartString device for the inflow anastomosis. The postoperative period was uneventful. Although an indication for this surgical technique should be tailored to the anatomy of the lesion, it is a reliable surgical option to achieve good outcomes.
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