There are many causes of acute limb ischemia. Trauma, thrombosis of the inflow and/or outflow tract resulting from atherosclerotic occlusive lcsions, or aneurysms arc common ones. However, in our experience most acute cases result from thromboemboll. Many of the principles of care of the ischemic extremity are the same irrespective of the etiology. I n 1978 Blaisdell, Steele, and Allen ~ reported in a comprehensive review an average mortality rate of ,25% and an average morbidity (amputation) rate of 40% with standard therapy, which is catheter thromboembolectomy. Consequently, they advocated treating these high-risk patients with "highdose" heparin initially and then selectively performing surgical reconstruction or amputation on those patients surviving. These numbers seemed high and prompted a 20-year review of our results since the advent of the Fogarty catheter embolectomy technique in 1963. 2 Since this report last year, a about 30 cases per year of acute ischemia resulting from embolism (90%) and thrombosis (10%) have been treated with about the same results. The methods of this retrospective, nonrandomized study have been previously published a and the results are summarized below in Tables I, II, III, and IV.