Objective: To evaluate the efficacy and safety of endovascular ultrasound-accelerated catheter-directed thrombolysis in patients with lower extremity arterial thrombosis through a systematic review and meta-analysis of published studies.

Materials and methods: A systematic literature search was conducted in the PubMed/MEDLINE database from January 1, 2005 to July 1, 2025. Seven studies (total 235 patients) met inclusion criteria. The risk of bias was assessed using RoB 2.0, ROBINS-I, Newcastle-Ottawa Scale, and JBI Critical Appraisal Checklist for Case Series. A random-effects meta-analysis was used to calculate pooled proportions for technical success, major bleeding, any reintervention, amputation, and all-cause mortality during short-term follow-up.

Results: The pooled technical success rate was 86.6% (95% CI 79.6–93.6%), with high heterogeneity (I²=65.2%, p=0.009). Major bleeding events were reported in 3.4% (95% CI 1.1–5.6%). Any reinterventions were observed in 7.4% (95% CI 0.2–14.5%, I²=56.9%, p=0.073). Lower extremity amputation rate was 2.3% (95% CI 0.1–4.4%), and all-cause mortality within 30 days was 1.3% (95% CI 0.2–2.9%).

Conclusion: Ultrasound-accelerated catheter-directed thrombolysis demonstrates a high technical success rate with acceptable complication and reintervention rates, and low 30-day mortality. The technique appears to be effective and safe for treating acute and subacute thrombosis of lower extremity arteries and bypass grafts. However, due to the low methodological quality of most included studies, the results should be interpreted with caution. Further high-quality randomized controlled trials with larger patient cohorts and longer follow-up are needed.

Gordey Vlasko, PhD, is an endovascular surgeon at the National Medical Research Treatment and Rehabilitation Center and a junior researcher at the Petrovsky National Research Center of Surgery (Moscow, Russia). His clinical and research interests focus on endovascular treatment of aortic and major arterial diseases. He is the author of 20 peer-reviewed scientific articles indexed in Scopus and RSCI, and a co-author of a national guideline on interventional radiology.