Objective: To evaluate the influence of pre-procedural characteristics on immediate and late results as well as the safety of catheter-directed thrombolysis (CDT) in acute ischemia of the lower extremity. Materials and Methods: A retrospective study comprising 249 patients treated by CDT from January 2006 to December 2012. Outcomes were primary patency, haemorrhagic complications, amputation and mortality. Results: Primary patency for CDT alone was 68%, for CDT plus endovascular treatment 87% and for successful CDT with supplementary surgery 62% giving an overall primary patency of 76%. Two (0.8%) patients suffered from cerebral haemorrhage during CDT. We found a significant correlation between 30 day amputation rate and no visual distal run-off at CDT start (OR 2.31; CI95% 1.09-4.91; p-value=0.02) and onset of symptoms to CDT start of 8-14 days (OR 4.09; CI95% 1.42-11.81; p-value=0.01). Lack of visualized distal run-off was also associated with a significant risk of 30 day mortality (OR 5.84; CI95% 1.26-27.00; p-value=0.02). Conclusion: Our results show that CDT is a feasible and safe treatment option especially when combined with angioplasty +/- stent. However, no distal run-off at primary angiography is associated with higher rates of amputation during follow-up and 30 day mortality.