Elephantiasis, characterized by chronic lymphatic obstruction and massive limb swelling, poses significant challenges in surgical management due to altered anatomy, difficulty in vein harvesting, impaired wound healing, and an increased risk of infection and fluid imbalance. These complications become especially critical when major procedures like coronary artery bypass grafting (CABG) are required. In such patients, standard surgical approaches may be compromised, demanding tailored strategies to minimize risk and optimize outcomes. We present a rare case of CABG using total arterial revascularization (TAR) in a patient with elephantiasis, illustrating the complexities of operative planning and execution in the presence of severe lymphatic disease. This case emphasizes the importance of preoperative assessment, multidisciplinary collaboration, and meticulous intraoperative technique. Careful postoperative monitoring is also essential to prevent complications and ensure successful recovery. Our report highlights that individualized approaches can lead to favorable outcomes even in technically demanding situations, demonstrating the viability of arterial grafting in anatomically and physiologically demanding scenarios.