Association of extracorporal assisted coronary bypass with peripheral vascular surgery has already placecommon in the therapeutic arsenal. This case report presents a combined cardiac and vascular surgery in a high risk patient, with unstable angina following myocardial infarction and critical ischemia of a single lower limb. Synchronous minimally invasive direct coronary bypass graft and extra-anatomic aorto-profundal bypass in one single sitting were performed. The procedure was successful at 6months follow up. We believe that this type of synchronous procedure, minimising surgical agression, could be effective in selected high risk patients.