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.

We report a 54‑year‑old woman with chronic pancreatitis, duodenal obstruction, massive ascites, and refractory thrombocytopenia who developed septic obstructive cholangitis after occlusion of a plastic common bile duct (CBD) stent. Endoscopic exchange failed and PTBD was prohibitively risky. Transjugular intrahepatic biliary stenting (TIBS) provides an alternative route that avoids transperitoneal hepatic capsule puncture. Via right internal jugular access, the right hepatic vein was catheterized, a posterior sectoral bile duct punctured, and a guidewire crossed the distal CBD stricture. A 12 × 80 mm self‑expandable metallic stent was deployed and the transhepatic tract embolized with coils. The patient experienced rapid clinical and biochemical recovery (bilirubin, 13.3 to 1.37 mg/dL) over 9 days postprocedure without any hemorrhagic complications. TIBS is a decisive, life‑saving alternative when standard routes are not possible.