Radical pancreatoduodenectomy was performed for a 69-year-old female with cancer of the pancreas head accompanied with atherosclerotic stenosis of the superior mesenteric artery (SMA). The patient was asymptomatic. On abdominal computed tomography, percutaneous cholangiography and endoscopic retrograde pancreatography, the common bile duct and main pancreatic duct of the body and tail were dilated. Preoperative angiography revealed that the SMA trunk had atherosclerotic stenosis and the blood flow of the SMA was supplied via the pancreatoduodenal arcades. Pylorus preserving pancreatoduodenectomy and thrombectomy of the SMA were performed. Pathologically, the pancreatic tumor was well differentiated adenocarcinoma. Adequate blood flow of the SMA was demonstrated angiographically on the 26th postoperative day. The postoperative course was uneventful and the patient was discharged on the 52nd postoperative day. The patient is cancer free and asymptomatic for atherosclerotic stenosis of the SMA at 1-year-9-months after the operation.