Acute aortic occlusion (AAO) is a high-mortality condition, and its occurrence during severe acute necrotizing pancreatitis (SANP) is rare. A 62-year-old male with SANP developed AAO. Urgent hybrid revascularization-including thrombectomy and the covered endovascular reconstruction of the aortic bifurcation (CERAB) technique guided by intravascular ultrasound (IVUS)-was performed. The patient recovered bilateral lower limb perfusion and distal pulses without requiring further vascular reinterventions or other major surgical procedures. However, he developed severe medical complications during the postoperative period, including pelvic infections and acute renal failure. Nonetheless, the patient recovered and was discharged on postoperative day 64. A hybrid approach-combining thrombectomy with IVUS-guided CERAB-appears technically feasible as an urgent revascularization strategy for AAO. However, despite procedural feasibility of a hybrid approach, the combination of AAO and severe SANP-related medical complications is associated with an elevated risk of short-term morbidity and mortality.

Objetivo: ilustrar los beneficios del ultrasonido intravascular (IVUS) en el tratamiento endovascular de la re-estenosis intra-stent (RIS) del sector femoro-poplíteo (FP) en un paciente con enfermedad renal crónica (ERC).Materiales y métodos: Hombre de 72 años con ERC y RIS FP recurrente. Se realizó aterectomía rotacional guiada por IVUS seguida de angioplastia con balón recubierto de fármaco (DCB-PTA), requiriendo 15 mL de contraste intraoperatorio.Resultados: el paciente recuperó pulsos distales y a los 6 meses permanece asintomático y sin signos ecográficos de RIS.Discusión: la aterectomía de RIS guiada por IVUS permite un tratamiento preciso, disminuye el uso de contraste y puede mejorar las tasas de permeabilidad. Aunque los resultados a corto y mediano plazo son prometedores, se requiere seguimiento a largo plazo para evaluar su rentabilidad y durabilidad. La intervención selectiva basada en la clínica y la imagenología es fundamental para el manejo de la ISR FP.

Postoperative chylothorax (POC) is an uncommon complication after thoracoabdominal aortic aneurysm (TAAA) open surgical repair. We report the case of a 70-year-old woman previously treated with ascending aorta replacement who presented with a 60-mm extent II TAAA. TAAA open surgical repair was performed. A POC was diagnosed on postoperative day 5. After failed conservative therapy, on postoperative day 24 a robotic-assisted thoracic duct (TD) ligation using indocyanine green fluorescence achieved POC complete resolution, the patient tolerated a full diet and was discharged. At the 3-month clinical follow-up, the patient is well. Robotic-assisted thoracic duct ligation with indocyanine green provided effective minimally invasive treatment with good results.

Crossed-fused renal ectopia is an uncommon congenital condition, and its association with abdominal aortic aneurysm can present a complex surgical scenario. We present a case of a 71-year-old male with abdominal aortic aneurysm and crossed-fused renal ectopia who underwent open surgical repair with renal artery reimplantation, using mannitol infusion and cold crystalloid perfusion for renal protection. Postoperatively, after transient creatinine rise, renal function normalized without dialysis. At 24 months follow-up, the reimplanted renal artery remains patent with normal renal function. This case illustrates open surgical repair's effectiveness in addressing complex vascular anatomy, ensuring durable outcomes, and preserving vessel patency and renal function.

Diego Soto V, Gabriel Cassorla J, Sebastián Morales Z, Gonzalo Velez M, José Segundo R, Julián Tique E, and Ángel Flores H. Vasc Specialist Int 2026;42:. https://doi.org/10.5758/vsi.260043