Objectives Early and accurate diagnosis of peripheral atherosclerosis is of paramount importance for global management of patients with known coronary artery disease (CAD), especially in the elderly. We sought to evaluate the prevalence and clinical relevance of significant abdominal vessel stenosis or aneurysm (AVA ) in patients undergo-ing coronary angiography. Methods Medical records of consecutive > 75-year old patients who underwent coronary angiography at two public institutions over a 12-month period were evaluated. Angiographic results of patients who un-derwent coincident diagnostic abdominal aorta angiography to evaluate abdominal vessels on the basis of clinical and angiographic criteria were analyzed. Results During the study period, AVA was found in 90 (35.7%) of 252 con-secutive patients (185 males, mean age 79 ±5.8 years), renal artery stenosis in 13.1% of cases (33 patients), aort-oiliac artery disease in 13.7 % (35 patients), and aortic aneurismal disease in 8.9% (22 patients). Logistic regres-sion analyses revealed > 3-vessel CAD (odds ratio [OR] :9.917, P = 0.002), and > 3 risk factors (OR: 2.8, P = 0.048) as independent predictors of AVA . Conclusions Aged patients with multivessel CAD frequently have a high risk profile and multiple vascular atherosclerotic distributions, suggesting the usefulness of a more global and compre-hensive cardiovascular approach in aged patients.