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Early and long-term results of treatment with local low-dose thrombolysis in 554 patients with 564 peripheral arterial occlusions are reported. Of 92 embolic occlusions present for 2 months or more, 59 (64.1%) were recanalized with a cumulative patency of 89.5% after 5 years. Of 472 thrombotic occlusions present for up to 6 months and more, 254 (53.8%) were successfully treated with a cumulative patency of 58.8% after 5 years. The hospital mortality and amputation rate were 1.6% and 1.95%, respectively. The average age of the patients was 69.1 years and more than half of those treated had stage III or IV disease. A 6-year experience with local low-dose thrombolytic therapy has completely confirmed its efficacy and has led to improvements in technique, which are described. The doses of streptokinase and urokinase needed for a successful result have been substantially reduced and the duration of treatment shortened. The number of complications has also been reduced. Differential therapeutic considerations compared to vascular surgery are mentioned. The results should motivate a reconsideration of the diagnostic and therapeutic measures to be used in the treatment of peripheral arterial occlusions.