Dethrombosis of the Lower Extremities: Pharmacologic and Mechanical Techniques

Thrombus is widely present in the peripheral vascula-ture and its frequency depends on the patient’s clinical presentation. Thrombus is almost always present in acute critical limb ischemia (ALI) and is commonly found in patients with subacute presentations, chronic critical limb ischemia (CLI) and chronic occlusions. The approach to dethrombosing a vessel depends on multiple factors, including the age of the thrombus, but generally requires a combination therapy with chemical lysis and rheolytic thrombectomy, such as the use of Power-Pulse Spray (P-PS) technique, or atherectomy with dethrombosing capa-bility such as the excimer laser. Surgery, or chemical lysis as a standalone therapy, carries very high rates of ampu-tation and mortality. The role of embolic protection devices is still unclear but is promising, as embolization of atherothrombus con-tinues to be a frequent occurrence during peripheral angioplasty. In this review, algorithms to treat thrombus in peripheral arterial disease are suggested