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.

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.