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Management of limb ischemia caused by radiation injury can be challenging. Atypical conduits or tunnels have been used for bypass through or around the injured area. Application of endovascular therapy for revascularization has not been widely published. Standard and alternative access sites with or without hybrid arterial adjuncts can be used successfully in cases in which surgical bypass is prohibitive. We describe a case of limb salvage in a patient treated with high-dose radiation for recurrent endocervical adenocarcinoma using a hybrid open surgical and endovascular approach.