Résumé : Twenty-two patients suffering from acute ischemia of the lower limbs were treated with local selective low-dose streptokinase, 2,000 U/min, with a maximum dose of 200,000 U, the average time of fibrinolytic infusion being 1.8 hours. Bleeding problems were minimized because of the low dose of fibrinolytic agent. Lysis, demonstrated by radiology, was achieved in 73%, but a good clinical result was obtained only when local fibrinolysis was associated with percutaneous transluminal angioplasty or surgery. Whether or not they had some lytic response, 16 patients required surgical intervention. Limb salvage was achieved in all cases. The long-term follow-up (twenty-six months) in 19 patients was entirely satisfactory with further surgery required later in only 2 cases.