Objective - to increase the safety of revascularization in combined atherosclerotic occlusion of extracranial arteries, terminal aorta and the main arteries of the lower extremities in conditions of risk of reperfusion-reoxygenation syndrome. 87 patients with associated lesion of extracranial arteries and aorto-ileum-femoral segment were examined and treated surgically. In 64 patients various variants of atherosclerotic occlusion of the aorto-femoral segment were diagnosed, in 44 of which a stenotic occlusal process of the femur-popliteal segment was established. In 31 (35.6%) patients, the occlusive-stenotic process of extracranial arteries was diagnosed. In order to prevent and treat patients with a risk of developing reperfusion-reoxygenation syndrome, preoperative preparation consisted of: elimination of vasoconstriction, reduction of neutrophil activity and level of systemic inflammatory response, increase of endothelium resistance, normalization of microvascular permeability, increase in pro-oxidant-antioxidant equilibrium activity. In 25 patients, one-stage surgery was performed on the extracranial arteries and the aorta-ileum-femoral segment. At the first stage carotid endarterectomy was performed. At the second stage - the revascularization of the aorta-ileum-femoral zone. All patients underwent aorto-bifemoral (64 observations) and one-sided ileo-femoral (16 cases) alloscout. On the third day after the aortic / ileum-femoral reconstruction surgery 25 patients underwent a hip-distal reconstruction. Systemic complex prophylaxis and terminal treatment of patients at risk of developing reperfusion-reoxygenation syndrome can prevent the development of deepening of ischemia of the lower extremity, renal failure and other severe reperfusion complications.