Novel Use of Lysis-Assisted Covered Endovascular Reconstruction of the Aortic Bifurcation (LA CERAB) in Acute Aortobiiliac Graft Thrombosis: A Case Report.

IntroductionAcute aortic occlusion (AAO) is a rare, life-threatening condition presenting with severe ischemia and requiring urgent intervention. While traditional open surgical approaches, including aortobifemoral and axillobifemoral bypasses, are well-established, endovascular techniques such as Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) have emerged as promising alternatives in select cases. This case introduces a novel modification termed Lysis Assisted CERAB (LA CERAB), combining thrombolysis and CERAB to manage acute graft occlusions.MethodsSingle-institution case report highlighting the utility of the LA CERAB technique in select patients.ResultsA 67-year-old male presented two years post-open aortobiiliac aneurysm repair with acute abdominal pain and bilateral limb ischemia without motor impairment. Initial CTA demonstrated complete thrombosis of his graft. He underwent percutaneous bilateral transfemoral catheter-directed thrombolysis. Post-thrombolysis angiography showed graft patency but significant residual thrombus. Subsequent LA CERAB successfully re-lined the graft, secured residual thrombus, and restored perfusion. The patient had an uneventful recovery, discharged home on therapeutic anticoagulation. Follow-up CTA at 2 months demonstrated sustained graft patency. This case highlights its applicability to acute presentations and adds to a growing body of literature on acute aortic graft occlusion interventions.ConclusionThe LA CERAB technique can serve as a novel, minimally invasive approach for select AAO patients presenting with high morbidity risks for transition open surgery. This case underscores patient-specific considerations in treatment strategy selection, illustrating how individualized surgical approaches can achieve favorable immediate and sustained clinical outcomes for future patients.