Objective To explore the safety and effectiveness of percutaneous mechanical thrombectomy (PMT) with Rotarex device in treatment of acute limb ischemia (ALI). Methods Totally 23 patients [(71.0±12.1)years old] admitted in our department from September 2016 to May 2017 were recruited in this study. All of them had sudden onset of coldness, numbness and painfulness in lower extremities, or sudden aggravation of intermittent claudication, and were diagnosed with acute arterial thrombosis via CT angiography (CTA) and digital subtraction angiography (DSA). According to the Rutherford classification, 2 patients (8.70%) were assigned into Grade Ⅰ, 15(65.22%) into Grade Ⅱa, and 6(26.09%) into Grade Ⅱb. They all received PMT using Rotarex device. Results Besides PMT with Rotarex device, 18 patients underwent balloon dilatation (9 with drug-coated balloon), 5 underwent stent implantation, and 5 received catheter-directed thrombolysis. There were 17 cases obtaining complete thrombus removal, 4 cases of most removal and 2 getting no removal, and the success rate of the approach was 91.3%(21/23). There were 19 caes recovering from all symptoms, 2 obtaining symptoms relief and 2 getting no improvement, and the clinical efficiency rate was 91.3%(21/23). Eight patients experienced occlusion of stented arteries, and recovered after operation. During the operation, distal embolization was seen in 3 cases, and angiorrhoxis in 1 case. During the follow-up period, 2 cases developed recurrent thrombosis of ipsilateral lower extremity. Conclusion Under strict indications, PMT with Rotarex device is safe and effective in the treatment of ALI.