Gluteal gangrene rarely complicates interventional procedures such as angiographic embolization in the pelvis or may develop postoperatively after open ligation or endovascular covering or embolization of one or mainly both internal iliac arteries in abdominal aortic surgery if collateral circulation is compromised. On the other hand, gluteal gangrene as a primary manifestation of chronic aortoiliac occlusive disease is very exceptional in literature. We present a patient with atherosclerotic aortoiliac obstruction and a necrotic eschar on her left buttock treated with aortobiiliac bypass after digital subtraction angiography. Internal iliac artery revascularization, even contralaterally, is crucial for the healing of necrotic tissue in these patients.