Catheter-directed thrombolytic treatment in an alternative method of treatment compared to the surgery of acute lower limbs ischemia. A case of acute lower limb ischemia due to occlusion of the vascular by-pass treated with guided thrombolysis with the use of a high doses of rtPA administered in a short period of time. Restoration of patency (revascularization) was achieved, and simultaneously complication in the form of peripheral embolism was found. After performing angioplasty of arteries occluded with embolism, total vascular revascularization and finally a very good clinical result were achieved.