Successful Coil Embolization of an Aneurysm in the Arc of Bühler

Abstract

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.

Spontaneous Retroperitoneal Hemorrhage Secondary to Chronic Celiac Axis Compression Treated with Embolization Utilizing Cone Beam CT

“…Ruptured PDA aneurysm secondary to MAL is extremely rare, and classic treatments included surgical aneurysmectomy, with or without reconstruction. However, rapid advances in interventional radiology have enabled the safe and effective treatment of visceral aneurysms and acute hemorrhage via transcatheter arterial embolization [14]. This has been supported by a recent study that concluded that coil embolization could be cost-effective and minimally invasive in certain cases, depending on the morphology and anatomy of the lesion [15].…”

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

“…Importantly, embolization of this aneurysm may result in a significantly greater blood flow at other vessels such as a pancreaticoduodenal artery resulting in recurrence of the aneurysm. Hence, careful and long-term follow-up is necessary [10]. Table 1 depicts some of the case reports highlighting the presentation and management deployed for this rare pathology.…”

The meta-analysis and systematic review of prevalence and clinical anatomy of the arc of Buhler

“…The AOB was first described in 1904 by Buhler 2 , who performed a series of dissections to establish the anastomotic variant, with a direct branch of the CAx forming a connection with a branch of the middle colic artery. Since its original discovery, the AOB has been mentioned numerous times in the scientific literature, usually described as a rare variant that is typically asymptomatic and is detected incidentally in patients who are undergoing imaging or abdominal surgery 3 , 4 .…”