Acute limb ischaemia poses a threat to both the limb and life of a patient. Until recently, attempted revascularization by thrombo‐embolectomy or vascular reconstruction held the best chance of limb salvage. Thrombolytic techniques afford an alternative method of management for this condition and are effective in selected patients. Low‐dose intra‐arterial streptokinase is the most established method of thrombolysis, although the recently developed tissue plasminogen activator offers a promising alternative. Intra‐arterial thrombolysis is not an easy option, being labour intensive and requiring close co‐operation between surgeon and radiologist. Thrombolytic and surgical techniques are not mutually exclusive but are best used to complement each other. Ideally patients with acute limb ischaemia should be managed by surgeons with knowledge of, and access to, optimal current surgical and non‐surgical techniques.