Results of surgical treatment were analyzed in 189 patients with lower limb arterial embolism admitted to hospital in terms from 7 up to 24 days from the onset of ischemia. 119 patients operated from 1 surgical approach formed group 1; 70 patients operated using additional second (tibio-medial or microtibial) approach formed group 2. The main criteria for application of additional approach were non-satisfactory retrograde blood flow, moderate atherosclerotic arterial changes and degree of ischemia. It is shown that group 1 presented with lesser amount of local complications (lymphorrhea, neuropathy) but higher frequency of re-thromboses and amputations. It is drawn a conclusion that additional approach in patients with acute lower limb ischemia caused by arterial embolism lower than inguinal ligament, with prolonged ischemia and thrombosis of distal arterial bed allows decreasing the frequency of amputations and improving results of surgical treatment.