Endovascular Management of Acute Limb Ischemia

After the invention of the thromboembolectomy balloon catheter by Fogarty in 1963, surgical revascularization has been considered the gold standard treatment in patients with acute limb ischemia (ALI). ALI is a dramatic event, carrying a high risk of amputation and perioperative morbidity and mortality. The technological advancement of the endovascular era has resulted in the definition and development of a variety of therapeutic options to assure arterial patency. In the 1970s, Dotter first introduced the idea of clot lysis in the treatment of ALI, which was modified to catheter-directed thrombolysis. Nowadays percutaneous thrombectomy devices have widely emerged as excellent alternatives to surgical approaches. Different devices with different mechanisms of function (fragmentation, rheolytic thrombectomy, aspiration) have been developed to overcome the limits of the pre-existing techniques. Every device has peculiar characteristics, points of strength and weaknesses and their use have to be tailored to the patient’s clinical and anatomical setting. In this chapter, the treatment options for ALI are detailed from surgical thromboembolectomy to thrombolysis and current endovascular techniques.