Objective To evaluate our early results of a combined minimally invasive surgery with surgical procedures for critical extremity ischemia. Methods From July 1999 to October 2000 intraluminal iliac minimally invasive surgery combined with simultaneous conventional surgery were performed on 20 lower extremities of 15 pa- tients suffering from critical multilevel atherosclerotic occlusive disease. There were 11 men and 4 women with an aver- age age of 73 years. The indications for surgery included disabling claudication in 6, rest pain in 9(included tissue gan- grenes in 3)patients. Mean preoperative ankle - brachial index(ABI)was 0. 35 ? 0. 18. Results 17 iliac mini mal- ly invasive approaches combined with simultaneous 11 femoro - popliteal bypass and 3 femoro - femoral popliteal by- pass as well as 5 profundaplasty were performed in 20 limbs of 15 patients. minimally invasive surgery were technically successful in all patients. One femoral - popopliteal bypass was failure. There were no additional instances of procedural or postoperative morbidity or mortality, and no wound - related complications. Postoperative ABI of femoral - popliteal bypass was 0.74 ? 0. 16(p