Objective: To evaluate the clinical efficacy of hybrid procedures in treatment of complex arteriosclerosis obliterans in the femoropopliteal segment. Methods: The clinical data of 56 patients (65 limbs) with complex arteriosclerosis obliterans affecting the femoropopliteal segment undergoing hybrid operation from March 2013 to June 2015 were retrospectively analyzed. The treatment efficacy was evaluated by analyses of the ankle brachial index (ABI), Rutherford category and patency rate. Patency was analyzed by using Kaplan-Meier method. Results: The hybrid procedures were successfully performed in all the 56 patients (65 limbs), no amputation was needed and no death occurred and the incidence of perioperative complications was 14.29% (8/56). The postoperative average ABI was increased compared with preoperative value (0.76 vs. 0.28), and the distance of intermittent claudication was prolonged from 168 m before operation to 530 m after operation, and both differences had statistical significance (both P<0.05); the Rutherford grades were improved in different degrees. The patients were followed up for 12 to 33 months, and the 0.5-, 1- and 2-year primary patency rate was 93.85%, 81.54% and 70.77%, and secondary patency rate was 98.46%, 95.38% and 90.77%, respectively. Conclusion: Hybrid procedures are safe and effective in treatment of complex arteriosclerosis obliterans in the femoropopliteal segment.