Interventional Management of Arc of Buhler Aneurysm

Abstract

The Arc of Buhler (AOB) represents a persistence of the ventral anastomosis between the superior mesenteric artery (SMA) and the celiac arterial systems. The exact incidence of the AOB is not known, but it is believed to be 4%. Aneurysms of this rare anomaly are even more uncommon. We report a case of an aneurysm of the AOB with an intact pancreaticoduodenal artery arcade (PDAA) and near occlusive celiac origin stenosis. Stenoses or occlusions of the celiac origin have been reported in association with AOB aneurysms, as well as in patients with PDAA aneurysms. Transcatheter embolization (TCE) was successfully performed, thereby excluding the AOB aneurysm while preserving flow through the PDAA. To our knowledge, this is the first report of successful percutaneous treatment of an AOB aneurysm. The pathophysiology and management AOB and PDAA aneurysms are reviewed. Review of the literature suggests that TCE, when feasible, is at least as effective as conventional surgery in patients with PDAA aneurysms, but with lower morbidity and mortality. Based on this data and our experience, we believe that TCE should be the initial treatment of choice in patients with PDAA or AOB aneurysms.

The arc of Buhler: special considerations when performing pancreaticoduodenectomy

“… Tokura (2002) [ 15 ] PDA aneurysm n = 1 TAE Saad (2005) [ 9 ] Liver transplant donors n = 4 n.a. Dubel (2007) [ 4 ] AOB aneurysm n = 1 TAE Jeong (2008) [ 5 ] AOB aneurysm n = 1 TAE Kallamadi (2009) [ 6 ] Mesenteric ischemia n = 1 n.a. Jayia (2011) [ 16 ] AOB aneurysm n = 1 TAE Rusu (2011) [ 17 ] n.a.…”

A Rare Cause of Post-Sphincterotomy Bleeding

“…2 Aneurysms of this rare anomaly are even more uncommon; very few cases have been reported in the literature. 1 In contrast, stenosis or occlusions of the celiac origin have been reported in association with AOB aneurysms. These aneurysms may be because of increased flow or pressure in these arteries in association with proximal celiac artery stenosis.…”

“…The arc of Buhler (AOB) is a rare anatomic variant and represents an anastomosis between the SMA and the CA systems. 1 The exact incidence of AOB is believed to be 4%. 1 In prenatal life, the SMA and CA arise from the aorta from the 10th and 13th segmental arteries, respectively.…”

“…1 The exact incidence of AOB is believed to be 4%. 1 In prenatal life, the SMA and CA arise from the aorta from the 10th and 13th segmental arteries, respectively. These segmental arteries usually regress with age and are connected by a ventral anastomosis.…”

“…Failure of this regression leads to persistence of the ventral communication between the SMA and the CA or one of its branches, which is called the AOB. 1 It may present in asymptomatic individuals but its recognition is important in patients undergoing interventions such as chemoembolization, mesenteric angiography, pancreaticoduodenal surgery, and liver transplantation. 2 Aneurysms of this rare anomaly are even more uncommon; very few cases have been reported in the literature.…”