Despite good immediate and remote results of endovascular treatment of patients with atherosclerotic lesions of the iliofemoral segment, involvement of the common femoral artery and the distal segment of the external iliac artery is often an argument in favor of open or hybrid surgery. Loop endarterectomy for this type of lesion has been successfully used for many years. However, unresolved problems remain that cause technical failure of the intervention and/or the development of intraoperative complications. The article presents an analysis of potential complications of the procedure and the causes of their occurrence, preventive measures and possible elimination from the perspective of various authors and our own experience. Besides, we herein describe two clinical cases accompanied by the development of such intraoperative complication as iliac artery perforation requiring immediate management.