-Case Reports-

Successful Coil Embolization of an Aneurysm in the Arc of Bühler

Fumie Sugihara¹, Satoru Murata¹, Fumio Uchiyama², Jun Watari², Hiroto Tajima³ and Shin-ichiro Kumita¹

¹Department of Radiology, Nippon Medical School, IVR Center, Tokyo, Japan
²Department of Radiology, Ebina General Hospital, Kanagawa, Japan
³Division of Gastroenterology, Department of Internal Medicine, Ebina General Hospital, Kanagawa, Japan

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.

J Nippon Med Sch 2016; 83: 196-198

Keywords
arc of Bühler, aneurysm, transcatheter arterial embolization

Correspondence to
Fumie Sugihara, MD, Department of Radiology, Nippon Medical School, IVR Center, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
giorcubgogo@nms.ac.jp

Received, May 25, 2015
Accepted, December 10, 2015