A 69-year-old man was referred to us with the diagnosis of abdominal aortic aneurysm (7 cm in diameter). Additionally his coronary arteriogram showed severe stenosis (LMT 75% and #6 99% delay). Because his ascending aorta was calcified severely, double CABG (LITA to LAD and RGEA to PL) was carried out in hypothermic ventricular fibrillation. Abdominal aortic aneurysm was replaced thereafter while the patient was still on cardiopulmonary bypass. His postoperative courses was satisfactory. In cases requiring early operation for both myocardial ischemia and abdominal aortic aneurysm, one stage operation was recommended. When atherosclerotic changes in the ascending aorta were severe, in situ arterial bypass grafting for ischemic heart disease under hypothermic ventricular fibrillation was useful.