Objective: To present the experience in hybrid procedure for TASC type D peripheral artery diseases (PAD). Methods: The clinical data of 22 patients (24 limbs) undergoing hybrid procedure for TASC type D PAD from October 2009 to December 2013 were retrospectively analyzed. Of the patients, 12 cases underwent iliac artery stent placement plus common femoral endarterectomy (including deep femoral endarterectomy) and profundaplasty with femoropopliteal prosthetic bypass, 4 cases underwent common femoral endarterectomy (including deep femoral endarterectomy) plus femoropopliteal prosthetic bypass and balloon dilatation of the anterior tibial artery or posterior tibial artery, and 6 cases underwent Fogarty catheter embolectomy plus iliac artery stent placement and common femoral endarterectomy (including deep femoral endarterectomy). Results: Technique success was achieved in all patients, and no perioperative death occurred. After operation, the pain was relieved and skin temperature was increased in the affected limbs, and the average ankle brachial index was increased from the preoperative 0.38 to postoperative 0.75. Eighteen patients were followed-up for 3 to 28 months; 2 cases developed postoperative thrombosis in the prosthetic bypass and one case developed stenosis in the stent, while no prosthesis- or stent-related complications occurred in any of the remaining cases. Conclusion: Hybrid procedure is minimally invasive, effective and safe. It is an appropriate choice for TASC D PAD, especially for those with high risk for single endovascular therapy.