Arterial diagnosis and management of acute thrombosis of the lower extremity.

Acute ischemia of the lower extremity is associated with reduced blood flow to muscle, nerve, subcutaneous tissue and skin. This condition may be caused by thrombosis on an atherosclerotic plaque or embolus or by the occlusion of a previously placed arterial bypass graft. The difficulties in differentiating embolic arterial occlusion from acute thrombotic arterial occlusion are discussed. Although balloon catheter thrombectomy has been the traditional approach to treatment of patients with acute ischemia, this method has several disadvantages: it may not remove all of the thrombus, the thrombus may be inaccessible, it may damage vessels and atherosclerotic plaque and it does not identify or correct the underlying cause of the thrombosis. The advantages of catheter-directed thrombolysis are discussed, including its use as a diagnostic tool. Detailed techniques are presented along with data from extensive studies.