Abstract Background: Open surgery of multilevel lower limb arterial disease has high morbidity. For treatment of such complex anatomy; Hybrid technique can provide durable and less invasive procedures tailored to medically high risk patients. Aim of Study: To evaluate hybrid management of symp-tomatic combined iliac and common femoral artery lesions. Patients and Methods: Prospective study was performed on 26 cases with symptomatic combined iliac and common femoral artery lesions. Hybrid approach was performed for all patients; open surgery for common femoral artery lesions and endovascular interventions for other lesions. Follow-up was 12 months. Results: All patients passed uneventful intra-operative course without technical failure; After the first month, primary patency was reported in 26 patients (100%) and limb salvage in 24 cases (92.3%). After 6 months; primary patency was observed in 24 cases (92.3%) and limb salvage in 22 patients (84.6%). After 12 months; primary patency was noticed in 18 patients (69.3%) and limb salvage in 20 patients (76.9%). Secondary patency was restored in 6 patients (23.1%). Conclusions: Hybrid approach; endovascular intervention for iliac and/or infrainguinal arterial lesions as an adjunct to open surgical repair of common femoral artery lesions, play a great role as a bailout for treatment of symptomatic combined iliac and common femoral artery lesions with satisfactory patency and limb salvage rates and allow effective, minimal invasive and durable therapeutic options especially in high risk patients.