Background and purpose: The coexistence of coronary artery disease (CAD) and peripheral artery disease is as frequent as 37% to 78%. Even though the coexistence of carotid artery stenosis or abdominal aortic aneurysm with CAD is a more common clinical situation, the prevalence of severe aorta iliac occlusive disease (AIOD) has been reported as 4% and 15% in different series of patients undergoing coronary artery bypass operation[1]. The purpose of this case study is to describe the precautions and physiotherapy interventions in a patient with coronary artery bypass grafting with axillo femoral bypass. Case Description: A 58 year old male patient with coronary artery single vessel grafting with axillofemoral bypass grafting was referred from post operative day 1 to day12 for physiotherapy. Twelve sessions of physiotherapy was continued till the discharge which included breathing Exercises, upper and lower limb exercises, airway clearance techniques and patient advice. Outcomes: Heart rate (HR), Respiratory rate (RR), Rate of perceived exertion, 6 minute walk test and spirometry were tested. Discussion: A significant increase in the heart rate and respiratory rate after the treatment in comparison to pretreatment measures. These parameters decreased significantly after 5 minutes and approached pre treatment values. The patient reported gradual reduction of dyspnea and was able to reassume functional activities. This was objectively supported by increased six minute walking distance and spirometric values. Physiotherapy management in a patient with coronary artery by-pass grafting with axillo femoral bypass resulted in significant increase in heart rate and respiratory rate with in physiological limits. Monitoring the vital signs is recommended in order to observe response to physiotherapeutic interventions. Hence supervision of moderate intensity exercise is very important to notice the increase in the cardiac respiratory endurance.