Objective: This study is evaluating the outcome of combined popliteal to distal bypass plus angioplasty of inflow lesions in critical limb ischemia (CLI) patients. Materials and Methods: Data of all CLI patients undergone infra-popliteal bypasses with inflow originating from the popliteal artery above the knee (Pop-AK) or below the knee (Pop-BK) are analysed retrospectively. Outcomes assessed are patency rates, amputation free survival, patient survival and wound healing rates at 1 year follow up. A comparative analysis of patency rates and amputation free survival between Pop-AK and Pop-BK bypasses is also done. Results: A total of 43 bypasses originating from the popliteal artery (19 Pop-AK and 24 Pop-BK) were performed in the period from March 2017 to February 2021 at Vascular Surgery Department - Zagazig University Hospitals - Egypt. Of which 25 necessitates preoperative endovascular treatment of femoro-popliteal lesions (18 males; mean age, 72.8 ± 10 years; Diabetes Mellitus, 88%; hypertension, 80%; renal impairment, 36%). The Trans-Atlantic Inter-Society Consensus II (TASC II) classification of femoro–popliteal lesions is TASC II-B in 21 (84%) patients, TASC II-C in 2 (8%) patients, and TASC II-D in 2 (8%) patients. 13 (52%) distal bypasses originated from Pop-AK and 12 (48%) from Pop-BK. The most common outflow artery is the anterior tibial artery (60%). At one year follow up, primary patency rate is 48%, assisted-primary patency is 84% and secondary patency rate is 96%. At 12months, amputation free survival and patient survival rates are 100% and 88%, respectively. Wound healing at 12 months reached 96%. Conclusion: Combined popliteo-distal bypass with inflow arterial angioplasty is a useful therapeutic option in treating CLI patients because of durable patency, acceptable wound healing rates and good limb salvage. This hybrid approach provides a good solution in cases of combined femoro-popliteal lesions with limited autogenous conduit.