Over the past 25 years there have been many developments in the percutaneous minimally invasive dissolution and removal of thrombus from the vasculature. Available methods include lysis by drugs, which enhance the body’s native thrombolytic system, and those which involve physical maceration and/or removal of clot. This chapter will focus in particular on the use of these techniques in acute arterial ischaemia. Surgical options in this condition include balloon embolectomy, bypass grafting and primary amputation. This cohort of patients frequently has much comorbidity and percutaneous methods offer a potentially less invasive option.