Many patients presenting for surgical revascularization of the lower extremities have progressive systemic atherosclerotic disease affecting not only the peripheral extremities, but also the coronary, cerebral, and renal vessels. Vascular patients are therefore considered high perioperative risk patients, making them a real challenge even for experienced anesthesiologists. This article analyzes a clinical case of hybrid angioplasty of lower extremity vessels in a patient with generalized atherosclerotic lesions under regional anesthesia with ultrasound navigation. Analysis of the clinical case and its analysis shows that regional anesthesia provides reliable protection against surgical stress with minimal impact on the body and should be used in patients with concomitant cardiac and pulmonary pathologies.