Acute synthetic portal graft thrombosis post–living donor liver transplantation (LDLT) is a rare, life-threatening complication. A 32-year-old woman with Budd-Chiari syndrome and chronic Yerdel grade IV portal thrombosis underwent LDLT using an expanded polytetrafluoroethylene jump graft from the superior mesenteric vein to the donor portal vein. Five months post-transplant, she developed acute graft failure and contrast-enhanced computed tomography confirmed complete occlusion with absent portal flow. Due to prohibitive surgical risk and lytic bleeding hazards, emergency transhepatic percutaneous mechanical thrombectomy with balloon angioplasty restored immediate portal flow without lytics. Liver function rapidly normalized, and the graft remained patent on Doppler ultrasound at 12-month follow-up. Emergency mechanical thrombectomy with angioplasty offers a feasible, effective endovascular salvage strategy for acute synthetic portal graft failure.

A 66-year-old man with pancreatic acinar cell carcinoma developed a hepatic metastasis that enlarged to 6.6 cm despite neoadjuvant FOLFIRINOX, pancreaticoduodenectomy, adjuvant chemoradiotherapy, and gemcitabine plus cisplatin. CT showed a heterogeneously hypoenhancing mass in the periphery of segment VI, an enhancement pattern predicting insufficient coverage by conventional chemoembolization alone. In a single session, 15 mL of an ethanol–doxorubicin–ethiodized oil mixture (1:2) was infused into the segment VI hepatic artery, and the resulting ethiodized oil deposition served as a fluoroscopic target for MWA guided by ultrasonography and fluoroscopy. A purulent perihepatic collection with pneumoperitoneum developed and resolved after percutaneous drainage. Complete response was sustained on follow-up CT, indicating that combined transarterial and thermal ablation can eradicate a large chemotherapy-refractory metastasis.