A 48-year-old male patient having none of the known risk factors for atherosclerosis underwent coronary artery bypass graft (CABG) surgery because of double-vessel coronary artery disease. During the operation, the aorta, both internal thoracic arteries (L/R-ITA), and the femoral artery were sclerotic, and CABG was performed using only saphenous vein grafts. A diagnosis of tertiary syphilis had been confirmed by either microscopic or serologic tests. There were different degrees of sclerosis in different arteries of different sizes. The presence of coronary artery disease with no known atherosclerotic risk factors should include preoperative testing for connective tissue disorders, chronic inflammatory disease, and cold hemagglutinins, because of the possible use of obligatory deep hypothermia or total circulatory arrest due to a diseased ascending aorta.