S6062 When the Gut Whispers Trouble: A Tale of Superior Mesenteric Artery Thrombosis After Celiac Artery Stenting

Introduction: Mesenteric ischemia is a diagnostic and therapeutic challenge, often presenting with vague symptoms that delay recognition. Endovascular procedures like celiac artery stenting have improved outcomes, but thrombotic events in adjacent vessels such as the superior mesenteric artery (SMA) can still occur. Acute mesenteric ischemia (AMI) affects 6.2 per 100,000 person-years, with SMA thrombosis comprising 15%–25% of cases (0.9–1.6 per 100,000). We report a rare case of SMA thrombosis 6 months post-celiac stenting, emphasizing the importance of collateral circulation and the role of imaging in early detection and management. Vigilant follow-up is essential, as silent vascular changes can lead to sudden clinical deterioration. Case Description/Methods: A 40-year-old man with mesenteric ischemia underwent successful celiac artery stenting. He had no history of diabetes, hypertension, smoking, or alcohol use. Six months later, he developed progressive abdominal pain and decreased appetite for 1 month. Workup suggested recurrent ischemia, and imaging confirmed SMA thrombosis. Digital subtraction angiography (DSA) via right radial access with a 6 Fr sheath under ultrasound and fluoroscopy showed a patent celiac stent with adequate hepatic and splenic artery flow. Mild gastroduodenal artery (GDA) stenosis and complete SMA occlusion from the origin were seen. Notably, the GDA provided collateral refilling of the distal SMA, likely limiting ischemic injury. Post-procedure, SMA flow was restored, and Doppler confirmed celiac stent patency. The patient’s symptoms gradually resolved. Long-term Ecosprin was initiated. Normal lipid profile, homocysteine, and thrombophilia panel ruled out hypercoagulability. Discussion: This case illuminates the dynamic vascular changes following mesenteric artery interventions. The initial celiac artery stenting likely succeeded, as evidenced by patent downstream vessels, yet the SMA thrombosis suggests a predisposition to thrombotic events. The GDA’s role in collateral refilling of the SMA demonstrates the body’s compensatory mechanisms, supported by the use of DSA under multimodal guidance, enabling real-time assessment and action. This case underscores the importance of longitudinal monitoring post-stenting, as late thrombotic complications can emerge silently, presenting as nonspecific symptoms. Advances in imaging and minimally invasive techniques have improved outcomes in such complex scenarios, reducing morbidity compared to open surgery.