A hybrid in-line aspiration technique using a coronary aspiration catheter directly connected to a mechanical thrombectomy pump for acute limb ischemia.

Acute limb ischemia requires rapid thrombus removal to restore perfusion and prevent limb loss. Although mechanical aspiration thrombectomy systems enable effective clot debulking, residual thrombus may persist in below-the-knee vessels that are less accessible to large-bore catheters. We describe a reproducible hybrid in-line aspiration technique in which a coronary aspiration catheter is connected directly to a mechanical thrombectomy pump, allowing continuous aspiration in the distal arteries. In an illustrative case of popliteal and tibial thromboembolism, this configuration facilitated effective thrombus extraction and complete revascularization. This simple off-label setup may expand endovascular options for complex acute limb ischemia.