This clinical case demonstrates an example of successful isolated repeat revascularization of the deep femoral artery using surgical and endovascular methods in a patient with rapidly progressive atherosclerosis and renal failure. Multiple attempts at direct revascularization for critical limb ischemia of the collateral lower limb for less than 2 years had resulted in amputation at the level of the thigh. With the development of critical ischemia of the contralateral limb, the tactics of indirect restoration of blood flow through the deep femoral artery made it possible to achieve regression of critical ischemia and save the limb. We consider it expedient to perform surgical treatment in patients with widespread atherosclerotic lesions of the distal segment, starting with isolated revascularization of the limb through the deep femoral artery. © 2023, Geotar Media Publishing Group. All rights reserved.