Chronic mesenteric ischemia is a rare disorder that is frequently associated with coronary artery disease. Myocardial ischemia is a leading cause of morbidity and mortality after revascularization of the splanchnic arteries. The optimal treatment of concomitant chronic mesenteric ischemia and myocardial ischemia is unknown. We report a case of this condition in a 57-year-old man who required revascularization of both the left anterior descending coronary and superior mesenteric arteries with venous grafts anastomosed to the ascending aorta. The patient remains asymptomatic after a 3-year follow-up. This good result argues for one-stage combined myocardial and mesenteric revascularization in selected symptomatic patients.