Buerger's disease (thromboangiitis obliterans) is a small- and medium-vessel vasculitis that predominantly involves the distal extremities. Coronary involvement in Buerger's disease is very unusual and rarely reported. We describe the unusual coronary angiogram findings of a 61-year-old Caucasian male with Buerger's disease who underwent cardiac catheterization for preoperative cardiac risk stratification prior to a carotid endarterectomy. Following the case presentation, we review the pathology, pathogenesis, and diagnostic criteria for Buerger's disease, and also include a review of the existing literature on coronary involvement in Buerger’s disease.