The article on the clinical case justified a new approach in the surgical treatment of patients with atherosclerosis obliterans of lower limb arteries. Hybrid operation allows to reduce the number of postoperative complications and overall mortality. Own experience of revascularization with distal lesions indicate the need for additional procedures when performing distal anastomosis using a synthetic prosthesis for improving remote patency of bypass grafts. This clinical case reflects the modern approach to surgical reconstruction of the leg arteries in patients with obliterating atherosclerosis of lower limb arteries.