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.

Acute SVC syndrome caused by extensive thrombosis requires prompt endovascular intervention. We report a 48-year-old female with colon cancer presenting with massive chemoport-related thrombosis involving the SVC, right atrium (RA), and bilateral brachiocephalic veins. Due to the lack of an embolic protection filter landing zone, we performed a novel plug-assisted thrombectomy (PAT) technique. A 20-mm vascular plug was positioned at the SVC-RA junction as a temporary tethered filter without detachment. Following mechanical thrombectomy, plug retrieval, and adjunctive balloon dilatation, the patient recovered and was discharged on day 12. This case demonstrates the technical feasibility of PAT as a proof-of-concept approach for embolic protection in patients with extensive SVC thrombosis where conventional filter placement is anatomically precluded.

Current percutaneous treatment strategies for acute limb ischemia (ALI) include catheterdirected thrombolysis (CDT) and mechanical thrombectomy. However, about 20% of these patients can have contraindications to thrombolytic therapy. Mechanical thrombectomy is the only option in such patients except for surgical candidates. Manual aspiration thrombectomy using a large-bore aspiration catheter is a preferred first option. However, this technique is sometimes insufficient when the thrombi burden is significant with the risk of distal embolization. In this case report, we would like to introduce a case with acute limb ischemia successfully treated with stentassisted thrombectomy when contraindicated for thrombolysis and failed simple aspiration thrombectomy alone.