Optimal activated clotting time during peripheral artery endovascular procedures: cutting the gordian knot

All endovascular procedures need an effective anticoagulation regimen that avoids thrombo-embolic complications due to the insertion and manipulation of various intravascular devices. Systemic heparinization reduces the risk of thrombosis but there is no conclusive evidence regarding the correct use of anticoagulant medications and accordant monitoring, especially in endovascular peripheral arterial procedures. An-ticoagulation must be maintained during the whole vascular procedure, especially during partial or complete blood flow interruption. Reaching and maintaining the correct coagulative status is mandatory to avoid or reduce thromboembolic complications that could limit the procedure's effectiveness or be harmful to the patient. Patients' baseline variables and procedure-related elements can influence the way anticoagulation should be administered and how coagulative status has to be monitored. This review aimed to clarify the critical points of anticoagulation and monitoring management for non-cardiac arterial procedures in order to understand the best way to manage vascular procedures anticoagulation.