Patients with aortic aneurysms frequently have concomitant coronary artery disease, which carries the potential for significantly increased perioperative morbidity. Most cases of severe surgically correctable coronary artery disease can and should be treated by a separate operation before aneurysmectomy to lower operative cardiac morbidity and enhance long-term survival. Infrequently, a patient can have both unstable coronary disease and a large symptomatic aortic aneurysm. In this situation, a single procedure combining coronary artery bypass followed by aneurysmectomy, as illustrated by this case report, is a reasonable option and should be considered in the cases of carefully selected patients.