Korean J Radiol.  2008 Jul;9(Suppl):S77-S80. 10.3348/kjr.2008.9.s.s77.

Transcatheter Coil Embolization of an Arc of Buhler Aneurysm

• Jeong SJ
• Lim NY
• Jang NK
• Choi SJ
• Kim JK
• Jeong YY
• Kang HK

• KMID: 1100111
• DOI: http://doi.org/10.3348/kjr.2008.9.s.s77

Abstract

We report the findings of a patient with an asymptomatic Arc of Buhler (AOB) aneurysm, which was successfully treated by transcatheter coil embolization. An abdominal CT and angiography revealed an intact pancreaticoduodenal artery arcade (PDAA) and an anomalous communication between the SMA and celiac axis, termed an AOB. An aneurysm was observed at the origin of the AOB and treated with a transcatheter embolization using coils. A follow-up CT imaging confirmed the total occlusion of the aneurysm with a patent PDAA. The successful results of this treatment suggest that the endovascular therapy of an AOB aneurysm with a celiac axis occlusion and an intact PDAA is feasible and safe.

Keyword

Superior mesenteric artery aneurysm; Transcatheter embolization; Coil

MeSH Terms

Adult
Aneurysm/radiography/*therapy
Angiography
Celiac Artery/*abnormalities
*Embolization, Therapeutic
Humans
Male
Mesenteric Artery, Superior/*abnormalities
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Coil embolization of Arc of Buhler aneurysm in 41-year-old man. A. Axial enhanced CT image shows 2 cm diameter aneurysm, which appeared to originate from superior mesenteric artery (white arrowhead). B, C. 3D CT angiography, at right posterior oblique view and left lateral view, delineated aneurysm (arrowhead) arising from another anastomotic artery between superior mesenteric artery and celiac axis, and intact pancreaticoduodenal artery arcade (arrow). D. Superior mesenteric artery angiography shows aneurysm and normal pancreaticoduodenal artery arcade (arrow) with occlusion at origin site of celiac axis (arrowhead). Retrograde filling of common hepatic artery and splenic artery from superior meseuteric arterys occurs via intact pancreaticoduodenal artery arcade and gastroduodenal artery. E. Post-embolization superior mesenteric artery angiography shows occlusion of aneurysm and intact pancreaticoduodenal artery arcade.

Reference

1. Buhler A. Uber eine anastomose zwischen den stammen der art celiaca und art mesenterica superior. Morpholog Jahrb. 1904. 32:185–188.

2. Tandler J. Uber die varietaten der arteria celiaca und deren entwicklung. Anat and Embryol. 1904. 25:472–500.

3. McNulty JG, Hickey N, Khosa F, O'Brien P, O'Callaghan JP. Surgical and radiological significance of variants of Buhler's anastomotic artery: a report of three cases. Surg Radiol Anat. 2001. 23:277–280.

4. Grabbe E, Bucheler E. Buhler's anastomosis. Rofo. 1980. 132:541–546.

5. Saad WE, Davies MG, Sahler L, Lee D, Patel N, Kitanosono T, et al. Arc of Buhler: incidence and diameter in asymptomatic individuals. Vasc Endovascular Surg. 2005. 39:347–349.

6. Kobayashi S, Yamaguchi A, Isogai M, Hori A, Kaneoka Y, Takeuchi Y, et al. Successful transcatheter embolization of a pancreaticoduodenal artery aneurysm association with celiac axis occlusion a case report. Hepatogastroenterology. 1999. 46:2991–2994.

7. Kugai T, Nakamoto T, Tamaki N, Sunagawa T, Kinjyo M, Nakama T, et al. Aneurysm of an artery of Buhler: an unusual case. J Vasc Surg. 1996. 23:537–538.

8. Myers JL, Losseff SV, Gomes MN. Surgical repair of an aneurysm of the Arc of Buhler in a patient with von Recklinghausen's disease. Eur J Vasc Endovasc Surg. 1998. 16:540–542.

9. Dubel GJ, Ahn SH, Saeed MA. Interventional management of Arc of Buhler aneurysm. Semin Intervent Radiol. 2007. 24:76–81.

10. Tien YW, Kao HL, Wang HP. Celiac artery stenting: a new strategy for patients with pancreaticoduodenal artery aneurysm associated with stenosis of the celiac artery. J Gastroenterol. 2004. 39:81–85.