Background : To evaluate the need for hybrid procedure in acute on chronic ischemia Methods: All patient who underwent interventions for acute limb ischemia from January 2018 to march 2019 were included . Study was prospective type and was done at SJICR. 44 patients were included in the study. Results: Out of 44 patients included in the study , 36 patient who underwent lower limb thromboembolectomy and 8 patient underwent hybrid procedures . Hybrid procedures included thromboembolectomy and endovascular procedures with on table angiogram in hybrid OT setting. Post procedural technical and clinical success noted with respect to decreased limb pain , increased limb warmth , improved toe and ankle movements and improved doppler ankle signals Conclusion: Hybrid procedures is the treatment of choice in acute on chronic limb ischemia . There is a need to subclassify acute limb ischemia as acute on chronic limb ischemia. SUMMARY : Acute limb ischemia is vascular surgical emergency which varied outcomes, even with prompt intervention .This original research describes a innovative way of managing of acute limb ischemia especially acute on chronic limb ischemia variant .