Acute Lower Limb Ischemia Research Articles

Unilateral upper and lower limb ischemia mimics stroke: a case report

BackgroundAlthough stroke and acute limb ischemia seem easily distinguishable by anamnesis and physical examination, symptoms may overlap and sometimes mislead the examiner. Such a situation can arise in the occurrence of unilateral neurological symptoms affecting the upper and lower limbs at the same time. As timely diagnosis and a correct therapeutic intervention are crucial to prevent irreversible damage in both diseases, knowledge of the possibility of one disease mimicking the other is essential. We present a unique case of acute unilateral upper and lower limb ischemia mimicking an acute stroke.Case presentationA 69-year-old Caucasian patient with known atherosclerotic risk factors was admitted to the emergency department with a suspected stroke with unilateral paresthesia. After a comprehensive examination of the patient with the need for repeated reevaluation and a negative brain computed tomography scan, acute left-sided upper and lower limb ischemia was eventually diagnosed. The patient underwent surgical revascularization of the upper and lower limbs with a satisfactory result and was discharged from the hospital after a few days.ConclusionIt is of utmost importance to always stay alert for stroke mimics, as overlooking can lead to severe complications and delay adequate therapy. Our case shows that persistent diagnostic effort leads to successful treatment of the patient even on rare occasions, as is the acute unilateral upper and lower limb ischemia.

An Unusual Cause of Acute Lower Limb Ischaemia

An Unusual Cause of Acute Lower Limb Ischaemia

Sex differences in outcomes after revascularization for acute lower limb ischemia: Propensity score adjusted analysis.

Previous reports have suggested higher rates of mortality and amputation for female patients in acute lower limb ischemia (ALI). The aims of the present study were to investigate if there is a difference in mortality, amputation, and fasciotomy between the sexes. A retrospective cohort study of consecutive patients undergoing index revascularization for ALI between 2001 and 2018 was conducted. A propensity score was created through a logistic regression with female/male sex as an outcome. Cox regression analyses for 90-day and 1-year mortality, combining major amputation/mortality, and logistic regression for major bleeding and fasciotomy, were performed. All analyses were performed with and without adjusting for propensity score. A total of 709 patients were included in the study of which 45.9% were women. Mean age was 72.1years. Females were older and had higher rates of atrial fibrillation, embolic disease, and lower estimated glomerular filtration rate, while men more often had anemia and chronic peripheral arterial disease. Mortality at 1year was 21.2% for women and 14.7% for men. The adjusted hazard ratio for 1-year mortality was 0.99 (95% CI 0.67-1.46). Fasciotomy was performed in 7.1% of female and 12.8% of male patients; the adjusted odds ratio was 0.52 (95% CI 0.29-0.91). Sex was not found to be an independent risk factor for mortality or combined major amputation/mortality after revascularization for acute lower limb ischemia, whereas women had lower odds of undergoing fasciotomy. Whether women are underdiagnosed or do not develop acute compartment syndrome in the lower leg as often as men should be evaluated prospectively.

Ultrasound-Guided Femoro-Sciatic Nerve Block versus Hemispinal Anesthesia in Acute Lower Limb Ischemia: A Prospective Randomized Comparative Study

Ultrasound-Guided Femoro-Sciatic Nerve Block versus Hemispinal Anesthesia in Acute Lower Limb Ischemia: A Prospective Randomized Comparative Study

Role of acute kidney injury in the treatment of acute lower limb ischemia

Role of acute kidney injury in the treatment of acute lower limb ischemia

A rare complication of acute lower limb ischemia post coronavirus disease 2019 infection in a healthy pediatric patient: case report

BackgroundCoronavirus Disease 2019 (COVID-19) is a novel respiratory disease that first emerged in 2019. Patients infected with this disease present with a myriad of symptoms. Limb ischemia and hypercoagulability are complications identified in adults. COVID-19-related vasculitis is a known but seldom reported complication in pediatric patients, and the treatment approach is still not well established.Case presentationWe report the case of a healthy four-year-old female with a history of COVID-19 who developed acute lower limb ischemia. This was initially treated as a case of acute snake envenomation by administering snake antivenom with no improvement. She eventually developed lower limb acrocyanosis with an inability to ambulate. The patient was started on interleukin-6 receptor inhibitors (tocilizumab), anticoagulants, and pulse steroid therapy. The patient had complete resolution with the loss of only one toe.ConclusionIdentification of thromboembolic complications in pediatric patients with no comorbidities and a history of COVID-19 can be difficult. Early recognition and treatment have a major impact on morbidity and can increase the likelihood of limb salvage.

Outcomes After Open Surgical, Hybrid, and Endovascular Revascularization for Acute Limb Ischemia.

To report the performance of surgical treatment (ST), hybrid treatment (HT), and endovascular treatment (ET) for patients with acute limb ischemia (ALI). This is a retrospective, comparative study of all consecutive patients with ALI treated in 2 tertiary centers between April 2010 and April 2020. Amputation and/or death (amputation-free survival; AFS) was the primary composite endpoint. Mortality, major amputation, and reintervention during follow-up were additionally analyzed. Proportional hazards modeling was used to identify confounders, results are presented as hazard ratio (HR) and 95% confidence intervals (CIs). In total, 395 patients (mean age=71.1±13.6 years; 51.1% female) were treated during the study period. Surgical treatment was preferred in 150 patients (38%), while 98 were treated by HT (24.8%) and 147 by ET (37.2%). Rutherford class IIa was the most common clinical presentation in the ET group (50.3%), whereas Rutherford IIb was most common in the ST (54%) and HT (48%) groups (p<0.001). Significantly, more patients presented with a de novo lesion in the ST and HT groups (79.3% and 64.3%, respectively) compared with ET (53.7%; p<0.001). Median follow-up was 20 months (range=0-111 months). In the multivariate analysis, ET showed significantly better AFS during follow-up compared with ST (HR=1.89, 95% CI=1.2-2.9, p<0.001) and HT (HR=1.73, 95% CI=1.1-3.1, p<0.001). Mortality during follow-up was also significantly lower after ET compared with ST (HR=2.21, 95% CI=1.31-3.74, p=0.003) and HT (HR=2.04, 95% CI=1.17-3.56, p=0.012). Endovascular treatment was associated with lower amputation rate compared with ST (HR=2.27, 95% CI=1.19-4.35, p=0.013) but was comparable with HT (HR=2.00, 95% CI=0.98-4.06, p=0.055). Reintervention rates did not differ significantly between the groups (ET vs ST: HR=1.52, 95% CI=0.99-2.31, p=0.053; ET vs HT: HR=1.3, 95% CI=0.81-2.07, p=0.27). Endovascular treatment for ALI was associated with improved AFS and comparable reintervention rates compared with open surgical and hybrid therapy. Treatment of acute lower limb ischemia remains a challenge for clinicians with high morbidity and mortality rates. Endovascular revascularization is considered first line treatment for many and hybrid treatments are becoming more common, however data is limited to either old trials, small series or with short follow-up. We present herein our 10-year experience with all available devices and techniques for open surgical, endovascular and hybrid acute limb ischemia treatments and compare their outcomes.

Abstract 12048: Aortic Vulnerable Plaques Including Cholesterol Crystals: Non-Obstructive General Angioscopy and Pathological Study

Introduction: Severe atherosclerosis of the aorta is known to be a risk of embolism to peripheral organs such as cerebral infarction and acute lower limb ischemia. Non-obstructive general angioscopy (NOGA) has high spatial and temporal resolution, and it is possible to dynamically observe various atherosclerosis in the aorta. Cholesterol crystals (CCs) which could be observed by NOGA scattered into the blood from ruptured plaques and caused inflammation. However, which NOGA-derived aortic plaques are high risk has not fully investigated yet. Aims: The purpose of our study was to evaluate aortic vulnerable plaques based on their frequency of scattering CCs. Methods: We investigated 52 consecutive patients with coronary artery disease who underwent NOGA between September 2021 and May 2023. Blood specimens were taken from a total of 118 NOGA-derived atheromatous plaques in the infrarenal abdominal aorta. Then, presence of CCs at each plaque was evaluated with polarized light microscopy using the filter paper rinse method. Results: The mean age of 52 patients in this study was 67.4 years, 82.7% were male, 36.5% had diabetes, 76.9% had dyslipidemia, and 82.7% had hypertension. CCs were detected in 28.8% (n=34/118) of the samples. The frequency of detection of CCs in aortic plaques was 52.5% for Puff Chandelier Rupture (PCR), 15.4% for Puff Rupture (PR), 4.5% for yellow plaques (YP), 0% for thrombi, and 0% for ulcer and fissure. P &amp;lt; 0.0001). Conclusions: Among aortic atherosclerotic plaques, many CCs were detected from PCR. PCR may be a vulnerable plaque that has a high impact on peripheral organs.

Acil Cerrahi Müdahale Gerektiren Akut Bacak Embolisinde Kırmızı Kan Hücresi Dağılımı-Trombosit Oranının Tanısal Değerinin Değerlendirilmesi

Background: The objective of this study was to evaluate the significance of the red blood cell distribution-to-platelet ratio (RPR) as a diagnostic indicator, derived from the initial hemogram measurements of patients who underwent emergent surgical treatment for acute leg embolism, by comparing it to a control group of healthy individuals. Methods: The study included 48 patients who underwent femoral embolectomy for acute lower limb ischemia, while an additional 49 individuals were enrolled as a control group. Demographic, clinical, and laboratory data were compared between the two groups. Using the receiver operating characteristic curve to determine the RPR cutoff value, the area under the curve, sensitivity, and specificity were calculated. Results: The age and gender distribution of both groups were comparable. The admission RPR values of patients who underwent surgery for acute embolism were statistically higher compared to healthy individuals (0.0677 (IQR: 0.0547-0.0803) vs. 0.0504 (IQR: 0.0441-0.0572), p&amp;lt;0.001). The area under the curve for acute extremity embolism was determined to be 0.832, and the RPR cut-off value of 0.566 was found to predict acute extremity embolism with a sensitivity of 72.9% and a specificity of 73.5% (p&amp;lt;0.001). Conclusion: Our findings provide preliminary evidence that RPR can be used as a novel diagnostic indicator for acute leg embolism. Rather than being used diagnostically alone, it is thought that a comprehensive evaluation of this ratio, when combined with the patient's medical history and other clinical findings, has the potential to expedite diagnostic process, particularly in healthcare settings with limited access to imaging resources.

TCT-144 The Clinical Impact of Access Site Selection for Local Thrombolysis and Intervention in Acute Critical Lower Limb Ischemia

TCT-144 The Clinical Impact of Access Site Selection for Local Thrombolysis and Intervention in Acute Critical Lower Limb Ischemia

Role of anticoagulation in nonagenarian patients with acute lower limb ischemia

Role of anticoagulation in nonagenarian patients with acute lower limb ischemia

Early results of endovascular treatment using percutaneous vacuum-assisted thromboaspiration in acute lower limb ischemia

Introduction. Open balloon thrombectomy and embolectomy remain the preferred initial option in the management of acute lower limb ischemia (ALI), but various endovascular techniques have become accessible and are growing in popularity. The aim of the study was to assess our early experience with percutaneous vacuum-assisted thromboaspiration using the Penumbra/Indigo® system for non-traumatic ALI. Material and methods. The study group comprised 13 patients with ALI who received treatment between September 2022 and June 2023; with 7 (53.8%) being males. The median age was 71 years (25%-75%IQR 62.5-77.5). ALI cases were classified according to the Rutherford scale: grade I – 2 (15.3%), grade IIA – 7 (53.8%), and grade IIB – 4 (30.7%). In 10 (76.9%) cases, ischemia was classified as “acute-on-chronic.” The occluded native vascular segment, determined through preoperative computer tomography angiography (n=4; 30.7%), duplex scanning (n=5; 38.4%), or both examinations (n=4; 30.7%), were as follows: superficial femoral artery (n=7) and popliteal artery (n=2). In two patients, thrombosis of the below-knee femoropopliteal bypass with autogenous vein was identified, while two others presented with femoral artery stent thrombosis. An embolic etiology of ALI was observed in 4 (30.7%) cases, and thrombotic etiology in 9 (69.2%) cases. Endovascular access was established via the ipsilateral common femoral artery (n=10), crossover (n=2), or brachial artery (n=1). Thromboaspiration was carried out using dedicated CAT6™ and CAT8™ catheters. Results. The technical success rate of vacuum-assisted thromboaspiration was 92.3%. Subsequent angiography revealed accompanying occlusive-stenotic lesions in all instances, necessitating transluminal angioplasty, and in 8 (61.5%) patients, additional stenting was required. Catheter-directed thrombolysis was utilized as an adjunct in one patient. There were 2 (15.3%) instances of distal embolization, both addressed within the same surgical session. Survival and limb salvage rates at the 30th-day follow-up stood at 100%. Conclusions. Utilizing the Penumbra/Indigo® system, percutaneous vacuum-assisted thromboaspiration appears to be a safe and effective minimally invasive technique for treating ALI. This method allows for the concurrent correction of coexisting chronic peripheral arterial lesions.

Determination of predictors of adverse outcome in patients with acute limb ischemia with a new coronavirus infection in the acute phase of the disease

Relevance. At the moment, the study relevance is determined by extremely insufficient coverage of this issue, which in turn directly affects managing patients with this pathology. Study objectives: to analyze outcomes of surgical treatment of patients with acute ischemia of lower limbs in connection with the new coronavirus infection and in­hospital mortality; to identify predictors of adverse outcomes; to construct a prognostic model for patients with acute limb ischemia and severe acute respiratory syndrome­related coronavirus­2 (hereinafter – SARS-­Cov-­2). Material and methods. Study design: single­center, retrospective study. We retrospectively analyzed 47 patients with acute limb ischemia (ALI) on confirmed SARS-Cov­-2 for the period from September 2020 to April 2022. In this study, we analyzed the mean age of patients, laboratory tests results, comorbidities, ischemia grade, imaging data, choice of treatment strategy, and in­hospital mortality. Statistical analysis revealed a correlation between clinical outcomes in patients with ALI and SARS­-Cov-­2 severity. Results. The mean age of the patients was 71.1  6.3 years. Acute ischemia of the upper limb was present in 3 of them. The mean concentration of D­dimer was 4,645 ng/mL. The mean level of ferritin was 969.1 µg/L. SARS-­CoV­-2 was confirmed in 100% of patients. The distribution of ALI grades (according to I.I. Zatevakhin's clasification) was as follows: 1 – 8.5% (n = 4); 2A ­ 44% (n = 21); 2B – 39% (n = 18); 3A – 8.5% (n = 4); 78.5% of patients received anticoagulants. Patients with comorbidities were distributed as follows: diabetes mellitus – 38.7%; hypertension – 85.3%; history of cerebrovascular disorders – 64.7%; AFib arrhythmias – 42.4%. The severity of viral pneumonia according to CT: CT1 – 12% (n = 6), CT2 – 19% (n = 9), CT3 – 29% (n = 14), CT4 – 21% (n = 10), CT was not performed – 19% (n = 8 because of the condition severity). Patients were grouped by intervention type: selective thrombolysis – 9%, surgical thrombectomy – 10%, endovascular interventions – 63%, hybrid interventions – 18%. Clinical outcomes (all­cause mortality, major cardiovascular events, repeat revascularization) were retrospectively evaluated. Using regression analysis, we found a correlation between the end­point and the severity of the underlying disease, assessed predictors of adverse outcomes, and constructed a prognostic model. Complications were also evaluated; according to our data, three patients had early thrombosis in their reconstruction zones and two patients had technical failures of revascularization of their lower leg and foot arteries. In­hospital mortality was 65.3%. Conclusion. Our prognostic model allowed to find a correlation between clinical and laboratory data and the end­point. Keywords: revascularization, SARS-­Cov­-2, thrombosis, acute ischemia, thrombotic events, endovascular interventions

Patients with Acute Limb Ischemia Might Benefit from Endovascular Therapy-A 17-Year Retrospective Single-Center Series of 985 Patients.

Acute lower limb ischemia (ALI) is a common vascular emergency, requiring urgent revascularization by open or endovascular means. The aim of this retrospective study was to evaluate patient demographics, treatment and periprocedural variables affecting the outcome in ALI patients in a consecutive cohort in a tertiary referral center. Primary outcome events (POE) were 30-day (safety) and 180-day (efficacy) combined mortality and major amputation rates, respectively. Secondary outcomes were perioperative medical and surgical leg-related complications and the 5-year combined mortality and major amputation rate. Statistical analysis used descriptive and uni- and multivariable Cox regression analysis. In 985 patients (71 ± 9 years, 56% men) from 2004 to 2020, the 30-day and 180-day combined mortality and major amputation rates were 15% and 27%. Upon multivariable analysis, older age (30 d: aHR 1.17; 180 d: 1.27) and advanced Rutherford ischemia stage significantly worsened the safety and efficacy POE (30 d: TASC IIa aHR 3.29, TASC IIb aHR 3.93, TASC III aHR 7.79; 180 d: TASC IIa aHR 1.97, TASC IIb aHR 2.43, TASC III aHR 4.2), while endovascular treatment was associated with significant improved POE after 30 days (aHR 0.35) and 180 days (aHR 0.39), respectively. Looking at five consecutive patient quintiles, a significant increase in endovascular procedures especially in the last quintile could be observed (17.5% to 39.5%, p < 0.001). Simultaneously, the re-occlusion rate as well as the number of patients with any previous revascularization increased. In conclusion, despite a slightly increasing early re-occlusion rate, endovascular treatment might, if possible, be favorable in ALI treatment.

Outcomes comparison between percutaneous decannulation with perclose ProGlide and surgical decannulation of veno-arterial extracorporeal membrane oxygenation.

Our study aimed to compare the decannulation-related outcomes of two different decannulation methods in patients who underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support, namely percutaneous decannulation with Perclose ProGlide device and conventional surgical repair. Surgical vascular repair is a standard strategy when ECMO is to be terminated and sometimes associated with severe complications. Percutaneous decannulation using Perclose ProGlide has been reported to be feasible and safe in selected patients, but there is a paucity of literature to make systematic comparisons between the two decannulation methods. 41 patients who were supported with VA-ECMO for refractory cardiogenic shock, cardiac arrest, or escort of complex interventions from December 2018 to December 2021 were enrolled. Of these, 30 underwent percutaneous Perclose ProGlide decannulation and 11 underwent surgical repair. The clinical characteristics and complication rates were analyzed. Patients in the two groups showed a similar incidence of vascular-related complications, such as acute lower limb ischemia, major bleeding, severe hematoma, pseudoaneurysm, and arteriovenous fistula [20% versus 18.2%, p=.896]. The incidence of groin infection and delayed healing was significantly higher in the surgical removal group [3.3% versus 36.4%, p=.014]. Percutaneous decannulation of veno-arterial extracorporeal membrane oxygenation with the Perclose ProGlide device is a feasible and safe technique that simplifies the decannulation process, shortens the hospitalization duration, and lowers the potential risk of groin infection and delayed wound healing.

Percutaneous Mechanical Thromboembolectomy in Acute and Subacute Lower Limb Ischemia: How I Do It

AbstractThis article describes the author's approach to peripheral arterial thromboembolism and describes the step-by-step access, approach, and technique depending on the site and location of occlusion.

A Rare Case of Acute Lower Limb Ischemia following Bee Sting

Bee sting entails allergic reaction that can be severe, sometimes even lethal as seen in our case report. These reactions can occur immediately after being stung. We report a case with arterial occlusion and severe ischemia in the lower limb a few hours after multiple bee stings. A 67-year-old male, a known case of hypertension and diabetes mellitus since 15 years and recently diagnosed with hypothyroidism, presented to the emergency department with multiple bee stings all over the body. Hence, he had developed bilateral lower limb edema with blackening of the left foot, which was gradually progressive in nature. Pedal pulsation were not palpable. After emergency treatment patient was subjected to Computed Tomography Angiography, suggestive of bilateral thrombotic occlusion of distal third of anterior tibial artery, posterior tibial artery and dorsalis pedis artery .patient was treated with systemic thrombolytic therapy and Anticoagulation.

Effect of dexamethasone therapy on factors of adhesiveness and coagulation in acute lower limb ischemia

Leukocyte-platelet adhesion during hypoxia, tissue damage, activation of inflammation and coagulation is associated with the expression of ICAM-1 membrane molecules and integrins by blood and tissue cells. At the same time, platelet adhesion receptors determine their adhesion to the endothelium and recruited lymphocytes. The role of platelets in the pathogenesis of ischemic cardiovascular diseases also consists in their ability to modulate both hemostasis and inflammatory reactions, which is accompanied by the secretion of inflammatory mediators and factors that promote the recruitment of leukocytes to tissue damage sites. Purpose of the study: to study the effect of the synthetic glucocorticoid dexamethasone on the expression of adhesion receptors CD18+ and CD54+ on leukocytes, the content of platelets and fibrinogen in the blood of patients with ALLI, the relationship of these indicators with the severity and outcome of the disease.To study the effect of anti-inflammatory therapy, a group of 32 patients treated with dexamethasone was formed; the comparison group was represented by 71 patients with basic therapy, the control group consisted of 15 volunteers. After revascularization, all patients received antiplatelet and anticoagulant therapy. Dexamethasone infusions were carried out in a course of 4 to 6 days after reconstructive surgery. In all patients, the content of C-reactive protein in the blood, the content of platelets and fibrinogen were determined. The number of lymphocytes expressing adhesion molecules ICAM-1 (CD54+) and integrins (CD18+) was counted using the immunocytochemical method. Studies were performed before surgery and on days 1, 3, 7, and 10 after surgery.With exacerbation of ischemia and damage to the endothelium, the accumulation of cytolysis products, the expression of adhesion molecules increases both on endotheliocytes and on inflammatory effector cells – leukocytes and platelets. Adhesion molecules conduct an activation signal inside the cell, which promotes adhesion of leukocytes and platelets to the endothelium, lymphocytic-platelet adhesion, the formation of a parietal thrombus, and possible occlusion of damaged vessels. Increased expression of adhesion molecules is associated with the activation of metabolism, inflammation, coagulation and oxidative stress, stimulates all hematopoietic lineages, including platelets. The level of involvement of cellular reactions in the pathogenesis of the disease affects the effectiveness and duration of treatment, the risk of recurrent thrombosis and death. Anti-inflammatory therapy with dexamethasone contributed to earlier remission, a decrease in the proportion of infectious complications, such as wound suppuration from 10% to 6%, the number of necessary amputations from 32% to 16%, the frequency of deaths from 31% to 6%, and a reduction in hospital stay from 13 days to 10.Inflammation, adhesiveness of effector cells and thrombosis are important factors in the pathogenesis of acute lower limb ischemia. Therapy with dexamethasone helps to reduce the level of systemic inflammatory response, the number of necessary amputations, the number of complications and adverse outcomes in the treatment of ALLI, and reduce the length of stay in the hospital.

COVID 19 and Acute Ischemia of Lower Limbs

COVID19 infection does not only affect the airways but it appears to progress to systemic disease in some patients. Pulmonary embolism remains the most commonly described event in patients with COVID-19 in intensive care, however, arterial thrombosis of the upper and lower limbs remains an unrecognized complication. Patients with this condition who have other risk factors must imperatively receive thromboprophylaxis based on low molecular weight heparin. We report here a case of bilateral acute ischemia of the lower limbs following covid 19 infection.

A single-centre protocol using low-dose urokinase for catheter-directed thrombolysis in the treatment of acute lower limb ischaemia.

Catheter-directed thrombolysis is one of the main treatments for acute limb ischaemia. Urokinase is still a widely used thrombolytic drug in some regions. However, there needs to be a clear consensus on the protocol of continuous catheter-directed thrombolysis using urokinase for acute lower limb ischaemia. A single-centre protocol of continuous catheter-directed thrombolysis with low-dose urokinase (20,000 IU/hour) lasting 48-72h for acute lower limb ischaemia was proposed based on our previous experiences. A retrospective study from June 2016 to December 2020 was conducted to evaluate the efficacy and safety of this protocol. The target lesion revascularisation, amputation and death were also monitored during follow-up. The Kaplan-Meier estimator was used for the subgroup analysis, and univariate and multivariate Cox regression analysis was applied to identify risk factors for reinterventions and death. 90 lower limbs were involved, including 51 Rutherford Grade I, 35 Grade IIa and four Grade IIb. During a 60.8-h thrombolysis, 86 cases (95.5%) were considered effective according to the angiogram. No major bleeding complication occurred during thrombolysis, and one amputation occurred after. Freedom from target lesion revascularisation, amputation and death were 75.6%, 94.4% and 91.1% during a mean 27.5-month follow-up, respectively. According to the Kaplan-Meier estimator, aortoiliac lesions had lower reintervention rates than femoropopliteal lesions (Log-rank p = 0.010), and cases without narrowing atheromatous plaque had a lower reintervention rate (Log-rank p = 0.049). Age was an independent risk factor for death (p = 0.038, hazard ratio 1.076, 95% confidence interval 1.004-1.153). The single-centre protocol of catheter-directed thrombolysis we proposed for acute lower limb ischaemia was effective and safe. Strict blood pressure control during catheter-directed thrombolysis ensured safety. Aortoiliac lesions and cases without narrowing atheromatous plaque had lower reintervention rates during follow-up.