Purpose Acute limb ischaemia is a vascular emergency due to its high risk for limb loss. Both open surgery and endovascular intervention are viable options to obtain revascularisation of the limb. The optimal strategy for limb salvage remains unclear. This study aims to compare surgical outcomes at 30 days in patients treated for acute limb ischaemia with either open surgical or endovascular revascularisation at a single rural centre over a five-year period. Methodology A retrospective cohort study design was used. Patients that presented to Wagga Wagga Base Hospital (New South Wales, Australia) with acute lower limb ischaemia requiring intervention between April 2019 and April 2024 were included in the study. Electronic medical records were accessed to identify patient demographics, the intervention and 30-day outcomes for each patient. Data recorded included diabetic status, level of occlusion, aetiology of acute limb ischaemia, and Rutherford classification. Results 87 patients underwent endovascular intervention, and 34 patients underwent open revascularisation. The mean age of patients was 67.4 years; 32.4 percent were women. At 30-day follow-up, amputation rates were 17.0 percent within the open group versus 9.0 percent within the endovascular group. Conclusion Endovascular treatment of acute lower limb ischaemia appears to have a lower rate of major limb amputation within 30 days. Further research with a greater patient population should be performed to confirm the advantageous efficacy of endovascular treatment over open surgical revascularisation.