The use of embolic protection device in lower extremity catheter-directed thrombolysis

Patients with peripheral arterial disease (PAD) are at increased risk for acute limb ischemia(ALI) predominantly arising from thromboembolic disease in atherosclerotic plaques,bypass grafts (60%) or emboli from a proximal source (30%) [1,2]. Endovascular and opensurgical approaches are available for managing acute thrombotic events in ALI. Minimallyinvasive intra-arterial catheter-directed thrombolysis in selected patients demonstratessimilar success rates to those of surgery [3]. However, pharmacologic thrombolysis in gen-eral carries a risk of embolization of micro-debris to distal sites. Overall, the risk of distalembolization in endovascular procedures of the superficial femoral artery (SFA) is around10% [4]. The use of embolic protection devices (EPD) results in up to 70% reduction inmicroembolic events in carotid artery interventions [5]. By contrast, catheter-directedthrombolysis with concomitant use of EPDs has not been previously reported in lowerextremity arteries.We present four patients with ALI in whom EPD was used during intra-arterial throm-bolytic infusion leading to reduced lytic time and pain while preserving distal runoffvessels.