Vakhitov D, et al. - Factors predisposing patients to recurrent acute lower limb ischemia (RALLI) were investigated via examining 303 acute lower limb ischemia patients [mean age of 71 years (standard deviation, 11.8 years); 159 (52.5%) men] treated with catheter-directed thrombolysis (CDT) at Tampere University Hospital and Turku University Hospital. Initial treatment with CDT was provided to a total of 164 (54.1%) native arterial and 139 (45.9%) bypass graft occlusions. Two hundred three patients underwent 204 additional endovascular or conventional surgical procedures following completion of CDT, in order to obtain adequate distal perfusion. RALLI occurred in 40 (24.4%) cases of native arteries and 90 (64.7%) cases of bypass graft during a median follow-up of 40 months (interquartile range, 69 months). The Cox multivariable regression analysis revealed an independent correlation of the absence of appropriate anticoagulant and antiplatelet medication with the development of acute reocclusions (hazard ratio, 6.51) in native arteries. Researchers observed the independent association of worsened tibial runoff (crural index III: hazard ratio, 2.40) with RALLI in bypass grafts. Superior limb salvage rates after reocclusion were observed among patients with synthetic conduits in comparison to native arteries or vein grafts. Findings thereby emphasize the great significance of appropriate post-thrombolytic antiplatelet or anticoagulant treatment after native arterial events and of adequate outflow in bypass graft patients