BACKGROUND Although the clinical efficacy of hybrid procedures in patients with chronic limb ischemia has been well reported in the literature, sufficient evidence is lacking in the acute setting. Our aim was to evaluate the immediate and midterm clinical results on 28 patients with acute lower limb ischemia treated with hybrid reconstructions on emergent basis, from January 2010 to March 2013 in our tertiary referral vascular center. METHODS A total of 28 patients (31 operated limbs) underwent emergent hybrid revascularization, with endovascular treatment performed proximally or distally to the site of open reconstruction. The median follow-up period was 6 months (range: 1-26). The immediate technical success was clinically and hemodynamically evaluated with an ankle brachial pressure index (ABPI) measurement. Six-month overall patency, limb salvage, and survival rate were also estimated. All analyses were performed with Kaplan-Meier life table method, using the STATISTICA 7.0 statistical program. RESULTS Twenty-seven patients presented with grade IIb and 1 with grade III ischemia, respectively. Technical success was achieved in all patients, whereas hemodynamic improvement rate was achieved in 98%. ABPI preoperatively was increased from 0.14 ± 0.1 to 0.69 ± 0.28 postoperatively (P < 0.05). Perioperative morbidity and mortality rates were 21% and 11% respectively. Six-month overall patency, limb salvage, and survival rate were 86%, 92%, and 79%, respectively. CONCLUSIONS Hybrid revascularization in immediately threatened limbs provides an effective and durable option with acceptable mortality and amputation rate in these high-risk patients. These findings should be further confirmed by larger scale clinical studies.