The article describes an example of successful surgical treatment of an elderly patient with an arterio-ureteral fistula in the presence of an infected vascular graft after numerous arterial reconstructions on the aortoiliac segment with the multidisciplinary team support. Restoration of the magistral blood flow in the aortoiliac region using bypass surgery or graft implantation relates to a technically sophisticated surgeries, especially in patients with severe concomitant diseases and previously implanted graft infection. This is associated with the high incidence of complications, which varies from 19.2 to 45% according to different sources. In such cases, extra-anatomic reconstructive interventions that are low-traumatic may be the method of choice for relieving critical ischemia. This approach in most cases becomes the only opportunity to save a limb in such clinical situation. A pronounced cicatrical adhesion process in the abdomen and retroperitoneum caused by numerous reconstructive surgeries on the infrarenal aorta in some cases can be the cause of ureteral strictures, which requires the involvement of a urologist in the treatment of such patients. Arterio-ureteral fistula (AUF) is an uncommon but potentially lethal complication. Despite increased number of reported cases and clinical awareness, AUF is not always detected in a timely manner. The prognosis in such cases can vary depending on the time interval from onset of clinical symptoms to the start of treatment. In the vast majority of cases, the AUF is located at the site where the ureter crosses over the bifurcation of the common iliac artery. Angiography is deemed the most effective procedure to diagnose AUF, although its sensitivity is only 62%. According to most authors, implantation of an endovascular stent graft for AUF is preferred over open surgery (mortality rate is 4 and 11%, respectively). However, an individual treatment strategy is developed in each specific case

Today, abdominal aortic aneurysm surgery is a fairly well-studied area of medicine. Nevertheless, some questions remain rather debatable. No clear criteria for giant aneurysms have been developed so far. The available foreign and domestic literature reports about 40 cases of surgical treatment of giant abdominal aortic aneurysms, 16 of which are cases of aneurysm rupture. Open surgery remains the method of choice in the treatment of giant aneurysms due to the pronounced technical difficulties of endovascular intervention. The authors present a case of successful surgical treatment of a giant aneurysm rupture in an elderly patient. The peculiarity of this patient's condition is the occurrence of aneurysm rupture after hospital admission. The patient refused surgical treatment for two years after aneurysm detection. On examination after admission, multispiral computed tomography revealed an aneurysm size of 101 mm. On the eve of surgery, pain syndrome in the left abdomen and tachycardia appeared. Aneurysm rupture was suspected and the patient was urgently admitted to the operating room. The surgery was performed under the conditions of machine reinfusion of autoblood. The patient underwent abdominal aortic aneurysm resection with linear prosthesis and retroperitoneal hematoma removal. The postoperative period had no peculiarities. On the 10th day after the operation the patient was discharged in satisfactory condition to the outpatient treatment. This clinical case demonstrates the possibility of successful surgical treatment of giant aneurysm rupture in elderly patients.