Objective: The present study was conceived to analyze the clinical benefit of hybrid interventions with surgical common femoral artery (CFA) reconstruction coupled to superficial femoral/popliteal endovascular recanalization for severe infrainguinal multilevel occlusive disease in high-risk ASA Class 3-4 patients. Material and Methods: From August 2008 until May 2015, a series of 143 hybrid infrainguinal interventions in 124 ASA Class 3-4 patients were performed in our department for Rutherford category 2-6 ischemic presentations. Patient demographics, specific risk factors, technical characteristics and patency results were retrospectively examined during a mean 36.8 months of follow-up. In a majority of 94 limbs (65%), the endovascular stage of interventions focused on long (>15 cm) femoropopliteal occlusions in parallel to regular CFA surgical revascularization. Two or three runoff tibial trunks were evinced in 84% cases, while one or none permeable vessel was found in 23 (16%) limbs. Results: Inasmuch surgical approach was successful in all cases, the endovascular stage was technically profitable in 134 (93%) cases. The ABI posto-peratively improved (>1.5) in 73% of cases, while clinical presentation gained at least one Rutherford category in 89% limbs. The mean hospital stay was 6.1 days (3-12 days) whereas the 30-day * Corresponding author. V.-A. Alexandrescu et al. 32 mortality rate in this homogeneous "high-risk" group of patients was 3.2%. Global risk factors alike age (>70 years/p = 0.0005), smoking (p = 0.0170) and female gender (p = 0.0111), together with CTOs length (>15 cm/p = 0.0470), severe calcifications (p = 0.0001), poor tibial runoff (p = 0.0001), TASC "C" and "D" lesions (p = 0.360 and p = 0.0394), the stent number (n = 3) and length (>6 cm) (p = 0.0039 and p = 0.0003) and the initial ABI scoring (p = 0.0051) showed statistical negative influence on primary patency. Conclusion: Hybrid infrainguinal revascularization may afford useful results in selected ASA "high risk" patients, owning low invasiveness, reproducibility and acceptable patency in return to punctual postoperative surveillance.