Lee J, et al. - Researchers sought to study the various techniques and clinical management paradigms using tissue plasminogen activator (tPA) to treat severe frostbite injuries, which are relevant to the interventional radiologist. They performed a literature search producing 157 citations; these citations were manually screened for inclusion criteria of case reports, case series, cohort studies, and randomized prospective studies that reported the use of tPA to treat severe frostbite injuries, of which 16 qualified for review. Two hundred patients with 1,109 digits at risk of amputation who were treated with intraarterial (IA) or IV tPA (116 and 77 patients, respectively) were analyzed. Treatment with IA tPA was provided in a total of 926 digits at risk and amputation of 222 digits was done for a salvage rate of 76%. Findings suggest devastating outcomes with loss of limbs and digits in correlation with severe frostbite injuries, yet tissue rewarming, prolonged watchful waiting, and often delayed amputation are involved primarily in clinical management. As per recent studies, promising results could be obtained using both IA and IV tPA to reduce amputation after severe frostbite injuries. In this work, a useful guideline has been provided for interventional radiologists including a suggested protocol, inclusion and exclusion criteria, and potential complications through a meta-analysis of thrombolytic therapy in the management of severe frostbite .