Intravascular Ultrasound-Guided Covered Endovascular Reconstruction of the Aortic Bifurcation for Acute Aortic Occlusion Concurrent with Severe Acute Necrotizing Pancreatitis: A Case Report.

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.