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Objectives: Acute limb threatening ischemia (ALTI) is one of the most widely seen emergent vascular interventions, and is highly associated with cardiovascular mortality and amputations. Despite successful endovascular treatment (EVT) strategies and surgical interventions mortality and morbidity rates still remain higher in patients with ALTI. In this study, we aimed to investigate the long term clinical outcomes which are amputation-free survival and mortality, in patients with ALTI who treated either with EVT or surgical embolectomy. Methods: Our study enrolled 86 consecutive patients who diagnosed with ALTI in our hospital retrospectively in between 2016-2020. The accurate diagnosis of ALTI was made by using color doppler ultrasonography or computed tomography angiography. Patients with acute infection who need antibiotics, chronic inflammatory disease, end-stage hepatic impairment, and malignancy were not included. Patients were divided into two groups as those who were treated with surgical method (group 1) and those who were revascularized by endovascular methods (group 2). Results: The mean follow-up period was 19 months (1-26). All-cause mortality and amputation rates of patients in surgery group and EVT group were statistically similar (14,3% vs. 27,3%, p:0,139 and 14,3% vs. 9,1%, p: 0,453 respectively). Kaplan-Meier survival analysis showed no significant difference in between EVT and surgery group in term of all-cause mortality and amputation. (log-rank p = 0.649). In multivariate logistic regression analysis, Rutherford stage, congestive heart failure and CRP/albumin ratio (CAR) was found to be an independent predictor of amputation and all-cause mortality even after adjusting for other confounding risk factors. Conclusions: In our study, we observed that EVT and surgical embolectomy had similar long-term outcomes in patients with acute limb threatening ischemia. We also observed that Rutherford clinical stage, congestive heart failure and high CAR may be an independent predictor of mortality and amputation. This data needs to be supported by larger and prospective studies. [ABSTRACT FROM AUTHOR]