With the increasing aging of our society, the number of surgeries for the elderly is also increasing. The elderly generally have many chronic diseases combined, which adds a great risk to their surgical treatment, e.g., 90 years old (or even 103 years old) or older are still undergoing surgery for femoral head replacement, etc. In the past 10 years, most doctors would not operate on patients of this age. However, for this group of patients, the surgery can be very beneficial in terms of improving their quality of life and even extending their life expectancy. However, the risk of surgery increases a lot, and most of the risks in such surgery are on the shoulders of anesthesiologists. On July 11, our vascular surgery department was scheduled to perform a diversion surgery for an 85-year-old man with a large blood vessel in one lower extremity. This elderly woman had 20 years of previous hypertension, 32 years of diabetes, 20 years of cerebral infarction, a period of dialysis for renal insufficiency (9 months ago, 3 months ago), and cardiac arrhythmias: ventricular premature, atrial fibrillation, and complete right bundle branch block. Cardiac ultrasound: mitral stenosis with incomplete closure and mild regurgitation. Moderate tricuspid regurgitation. Aortic stenosis with incomplete closure. Wind heart disease. Hyperuricemia for 8 months, hyperlipidemia for 2 years. PICC placement status. Severe osteoporosis. History of lumbar disc herniation (L2-L3, L3-L4, L5-S1). Pulmonary hypertension (moderate). He has been bedridden for almost six months. He had been taking oral anticoagulant aspirin for a long time because of bilateral lower extremity atherosclerosis, and could not stop it intraoperatively. The patient was evaluated before anesthesia with an ASA rating of IV, second only to the highest level V (i.e., life threatening at any time). For such a patient, we all attached great importance to surgical anesthesia, and the whole department had a detailed discussion. The whole department discussed carefully about what kind of anesthesia plan to choose: if we choose intravertebral anesthesia (hemi-anesthesia), the patient may have intravertebral hemorrhage due to anticoagulants, which may compress the spinal cord and lead to paraplegia; and the patient has a history of lumbar disc herniation, which will make puncture difficult, so this plan is not possible. Choose general anesthesia: the elderly have bad heart, ventricular premature, atrial fibrillation, complete right bundle branch block, pulmonary hypertension, there will be great fluctuation of vital signs or even cardiac arrest after general anesthesia, postoperative can not be extubated, possible lung infection, etc. This option is also eliminated. Half-body anesthesia is not possible, and general anesthesia is not possible, so what should we do? We chose to perform combined lumbar plexus nerve and sciatic nerve block anesthesia under the guidance of ultrasound and nerve stimulator at the same time, which avoided the possibility of hematoma in the spinal canal and also avoided the risks associated with the application of general anesthetics. The anesthesia is limited to the affected limb on the side of the operation and does not affect the contralateral limb at all, which minimizes the impact on the patient’s vital signs and makes it smoother, i.e., safer. However, this type of plexus block anesthesia requires a high level of anesthesia skill, and if not done properly, poor anesthesia can result in intraoperative pain, which is equally detrimental to the patient. We still decided to accept this challenge. In the end, due to our careful preparation and meticulous and patient operation, we achieved a satisfactory anesthetic effect, and the operation was carried out smoothly. The operation was completed after 2 hours and 12 minutes, and the patient’s vital signs were stable during the operation (see the attached picture), and there was no pain at all. Through our efforts, we were able to complete the surgery and ensure the safety of the patient at the same time, which made us feel happy and satisfied as well as the great responsibility on our shoulders! Everyone in our department is filling our national key clinical specialties with real and important connotations, making the comprehensive strength of our department even stronger and more powerful.