Blind surgical coronary revascularization.

A 53-year-old woman presented with unstable coronary artery disease and severe peripheral vascular disease that prevented brachial, axillary, and femoral access for coronary angiography. Intensive medical management failed with ongoing angina, dynamic ECG changes, hemodynamic instability, and biochemical evidence of reinfarction. Coronary artery bypass grafting was performed without preoperative angiography. Each major coronary territory was grafted. The patient recovered postoperatively without angina at 1-year follow-up.