The paper demonstrates a clinical case of open surgical re-interventional on the abdominal aorta 8 years later after primary aortofemoral bypass through the right and left retroperitoneal accesses. Severe ischemic damage to the tissues of both lower extremities required repeated vascular reconstruction. The tactics of repeated retroperitoneal intervention on the aorta was chosen, while the access could be expanded to thoracophrenolumbotomy. Due to the pronounced cicatricial process in the retroperitoneal space and intraoperative damage to the ureter, the branches of the prosthesis were performed in an atypical manner.