Spinal tuberculous osteomyelitis eroding into the aorta is an extremely rare entity. The case of an 80-year-old man with a large proximal anastomotic pseudoaneurysm above an aortobiiliac prosthesis involving the suprarenal aorta is reported. A periaortic and perigraft fluid collection was found to be contiguous with an osteolytic process of the anterior bodies of the T12 and L1 vertebrae. Staged extraanatomic axillobifemoral bypass, graft excision, and viscerorenal revascularization with superficial femoral- popliteal veins were performed. The pathologic diagnosis of spinal tuberculous osteomyelitis was made. The rare entity of Pott's disease of the spine involving the suprarenal aorta and an aortic prosthesis presented significant challenges in resection and revascularization. The use of the deep veins of the legs as large-diameter autogenous conduit facilitated visceral and renal arterial bypass in an infected field.