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

## TL;DR

A patient with severe artery blockage had a successful stent placed in the mesenteric artery after a complex pancreatic surgery, preventing intestinal and liver damage.

## Contribution

This case highlights the novel use of postoperative SMA stenting to manage mesenteric ischemia in high-risk patients after pancreaticoduodenectomy.

## Key findings

- Postoperative SMA stenting via the left brachial artery restored blood flow and resolved symptoms.
- Mesenteric perfusion assessment is critical in patients with severe atherosclerosis undergoing PD.

## 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.