Postoperative superior mesenteric artery stenting following pancreaticoduodenectomy in a patient with severe mesenteric atherosclerosis

Abstract Pancreaticoduodenectomy (PD) in patients with severe mesenteric atherosclerosis carries a risk of hepatic and intestinal ischemia after ligation of the gastroduodenal artery (GDA). We report the case of a 69-year-old male with pancreatic head adenocarcinoma who underwent PD. Intraoperatively, hepatic artery flow was only pressure-dependent after GDA division. Postoperatively, he developed abdominal pain and emesis. Computerized tomography angiogram showed near-occlusive celiac and thrombosed superior mesenteric artery (SMA) with inferior mesenteric artery (IMA) collateralization. SMA stenting via the left brachial artery restored flow and resolved symptoms. This case underscores the importance of assessing mesenteric perfusion and considering early SMA stenting in high-risk patients prior to PD.