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.