Transcollateral retrograde recanalization of superior mesenteric artery occlusion through the pancreaticoduodenal arcade

We present a case of an 86-year-old female with chronic mesenteric ischemia secondary to long-segment flush occlusion of the superior mesenteric artery and near-total occlusion of the celiac artery. The superior mesenteric artery was unable to be revascularized by conventional antegrade approaches. Successful transcollateral crossing of the occluded superior mesenteric artery and body-flossing, followed by antegrade balloon angioplasty, shockwave lithotripsy, and stent implantation were performed. This case demonstrates that retrograde recanalization via collateral pathways is a viable alternative for patients with superior mesenteric artery flush occlusion when conventional antegrade approaches fail.