Aneurysm of an artery of Buhler: An unusual case

Kugai, Tadao; Nakamoto, Tsuguo; Tamaki, Nobuharu; Sunagawa, Toru; Kinjyo, Morito; Nakama, Tsukasa; Fujimi, Satoshi; Mabuni, Katsuto; Omine, Hiroumi; Uchima, Hisataka

doi:10.1016/s0741-5214(96)80024-3

Cited by 13 publications

(11 citation statements)

References 3 publications

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“… n = 14 n.a. Kugai (1996) [ 13 ] AOB aneurysm n = 1 Resection Myers (1998) [ 14 ] AOB aneurysm n = 1 Resection, vein grafting McNulty (2001) [ 3 ] Gastrointestinal hemorrhage n = 3 n.a. Tokura (2002) [ 15 ] PDA aneurysm n = 1 TAE Saad (2005) [ 9 ] Liver transplant donors n = 4 n.a.…”

Section: Case Presentationmentioning

confidence: 99%

The arc of Buhler: special considerations when performing pancreaticoduodenectomy

et al. 2016

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A 74-year-old female was diagnosed as having a carcinoma of the papilla of Vater. Preoperative computed tomography showed stenosis of the celiac trunk and an enlarged artery arising from the superior mesenteric artery (SMA) joining the root of the splenic artery. Since this artery communicated with the SMA and the celiac trunk, independently of the gastroduodenal and dorsal pancreatic arteries, it was considered to be the arc of Buhler (AOB). The arterial blood flow to the liver, spleen, and stomach appeared to depend on the AOB, such that AOB preservation was considered to be essential. A subtotal stomach-preserving pancreaticoduodenectomy with preservation of the AOB was thus performed. Although AOB is a relatively infrequent type of arterial communication between the SMA and the celiac trunk, it needs to be preserved during pancreaticoduodenectomy when celiac trunk stenosis is present.

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Section: Case Presentationmentioning

confidence: 99%

The arc of Buhler: special considerations when performing pancreaticoduodenectomy

et al. 2016

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“…Kugai described aneurysmectomy of 3-cm saccular AOB in a patient with a celiac artery occlusion. Surgery was performed without revascularization of the Celiac artery after attempts at failed embolization [12]. Closely related differential diagnosis to the AOB is the pancreaticoduodenal artery arcade (PDAA).…”

Section: Discussionmentioning

confidence: 99%

Arc of Buhler Pseudoaneurysm Causing Fatal Retroperitoneal Hemorrhage; A Rare Case Report and Discussion of Relevant Literature

Biswas¹,

Gogna²

2019

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Identification of any variant anatomy prior to surgery is as essential as having knowledge of normal anatomy. These surprises bring on many challenges along with as they can be fatal. We encountered a case of patient who succumbed down to an unrecognized rare mesenteric vasculature variant known as “Arc of Buhler” (AOB) which is a persistent embryonic ventral anastomosis between the Celiac trunk and the Superior mesenteric artery. It is usually asymptomatic and found incidentally after evaluation for other pathologies. We herein report a pseudoaneurysm of Arc of Buhler being surgically managed after massive retroperitoneal hemorrhage. Unfortunately, the patient did not survive the procedure and passed away. AOB aneurysms present formidable risks to patients and diagnostic and therapeutic challenges to physicians. They are rare and require high index of suspicion on radiographic imaging. Present case reports underscore the importance of identifying it and treating it regardless of the size.

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“…The diameter of these reported aneurysms has ranged from approximately 2.0 to 6.0 cm. Surgical treatment was performed in 2 cases 8,9 , including one case wherein transcatheter arterial embolization of the aneurysm was unsuccessful.…”

Section: Discussionmentioning

confidence: 99%

Successful Coil Embolization of an Aneurysm in the Arc of Bühler

et al. 2016

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In the present report, we describe a case of a patient with an asymptomatic aneurysm in the arc of Bühler (AOB), which was successfully treated by transcatheter arterial embolization. The patient presented with severe stenosis of the celiac trunk, which was suspected to be due to median arcuate ligament syndrome. Arteriography of the superior mesenteric artery indicated a rapid stream in an aneurysm in the AOB. Hence, embolization was carefully performed using detachable coils and microcoils. An arteriography performed after embolization did not show any aneurysm, and the hepatic artery and splenic artery could be detected via the pancreatic arcade, originating from the superior mesenteric artery. The AOB is a persistent embryonic ventral anastomosis present between the superior mesenteric artery and the celiac artery. This anastomotic artery is independent of the gastroduodenal artery and the dorsal pancreatic artery, and is extremely rare, with an incidence of <4%. Aneurysms of the AOB are even more uncommon, and such cases have been reported in association with stenosis or occlusion of the celiac trunk. Open surgical aneurysmectomy, with or without reconstruction, is the conventional treatment for such aneurysms. However, rapid advances in interventional radiology have enabled the safe and effective treatment of visceral aneurysms via transcatheter arterial embolization. Based on the current findings, we believe that transcatheter arterial embolization is a minimally invasive and valuable method that may serve as an initial treatment option for aneurysms of the AOB.

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Aneurysm of an artery of Buhler: An unusual case

Cited by 13 publications

References 3 publications

The arc of Buhler: special considerations when performing pancreaticoduodenectomy

The arc of Buhler: special considerations when performing pancreaticoduodenectomy

Arc of Buhler Pseudoaneurysm Causing Fatal Retroperitoneal Hemorrhage; A Rare Case Report and Discussion of Relevant Literature

Successful Coil Embolization of an Aneurysm in the Arc of Bühler

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