The final goal of vascular surgery is to prevent amputation and maintain walking ability. Many surgical techniques for peripheral arterial disease (PAD) have been reported. The combined use of endovascular and open techniques (hybrid) in the same surgical setting has been reported since the mid-1990s, and has gained popularity over time as vascular surgeons have acquired increasing experience with endovascular interventions. The hybrid operation offers adequate access for the treatment of both inflow and outflow lesions, while dealing with the common femoral artery lesion in the most appropriate way. The main advantage of hybrid procedures is the ability to treat more complex anatomy by less invasive procedures in patients who are considered as high medical risk. Extensive revascularizations can be accomplished without significant hemodynamic changes, minimal blood loss, and limited risk of preoperative complications. Therefore, the hybrid procedure was thought to be an acceptable strategy in PAD patients with severe lower extremity arterial disease and may provide less invasive therapeutic options tailored to the needs of high risk patients with multiple lesions.