[Arterial thrombolysis in peripheral arterial occlusions--where are the limits of the realm and what are the responsibilities of a vascular surgeon?].

Arterial thrombolysis is a well established treatment for acute myocardial ischaemia, with respectable results. It is gaining ground in peripheral vascular surgery as well, particularly in the treatment of acute ischaemia due to occlusion of a sclerotic artery or an arterial graft. However, in case of myocardial ischaemia diagnosis (coronary angiogram), treatment (thrombolysis, PTCA or revascularisation) and recognition for the need for acute surgical treatment are in the same hands in cardiology, in case of peripheral arterial occlusions diagnostics (and therapy in some extent) are provided by radiologists, while patients are usually referred to vascular surgeons. They can provide limited diagnostics (intraoperative angiogram) and can treat patients by non-surgical means (i.e. intraoperative thrombolysis). Although co-operation between radiology and vascular surgical services is crucial and can save limbs and lives, in everyday practice we frequently have to decide whether the ischaemic limb can be treated by thrombolysis only (carried out by radiologists) or the extent and stage of ischaemia are such that they require the faster surgical reconstruction, often completed with intraoperative angiogram and thrombolysis. Whose decision should it be? Should vascular surgeons force thrombolysis, should they do it themselves? What are the cost implications of the successful and unsuccessful thrombolysis?