Two cases with a pancreaticoduodenal arterial aneurysm accompanied with superior mesenteric artery(SMA) stenosis were previously described and both were treated surgically.However,for interventional treatment,securing a sufficient blood supply to the SMA should be a priority of treatment.We present the case of a 71-year-old male with a 20 mm diameter pancreaticoduodenal arterial aneurysm accompanied by SMA stenosis at its origin.The guidewire traverse from SMA to the aneurysm was difficult because of the tight SMA stenosis;however,the guidewire traverse from the celiac artery was finally successful and was followed by balloon angioplasty using a pull-through technique,leading to stent placement.Thereafter,coil packing through the SMA achieved eradication of the aneurysm without bowel ischemia.At the last follow-up computed tomography 8 mo later,no recurrence of the aneurysm was confirmed.The pull-through technique was useful for angioplasty for tight SMA stenosis in this case. Two cases with a pancreaticoduodenal arterial aneurysm accompanied with superior mesenteric artery (SMA) stenosis were previously described and both both were treated surgically.However, for interventional treatment, securing a sufficient blood supply to the SMA should be a priority of treatment .We present the case of a 71-year-old male with a 20 mm diameter pancreaticoduodenal arterial aneurysm accompanied by SMA stenosis at its origin. The guidewire traverse from SMA to the aneurysm was difficult because of the tight SMA stenosis; however, the guidewire traverse from the celiac artery was finally successful and was followed by balloon angioplasty using a pull-through technique, leading to stent placement. Afterafter, coil packing through the SMA achieved eradication of the aneurysm without bowel ischemia. At the last follow-up computed tomography 8 mo later, no recurrence of the aneurysm was confirmed. The pull-through technique was useful for angioplasty for tight SMA stenosis in this case.