A Case of the Arc of Bühler Aneurysm Required Staged Coil Embolization

Abstract

The Arc of Bühler (AOB) is considered a remnant anastomotic vessel between the superior mesenteric artery and the celiac artery (CA) during the embryonic period, it is a rare anatomical variation and its frequency is 1–4%. AOB aneurysm by stenosis or occlusion of the CA with median arcuate ligament syndrome occasionally requires treatment. A 77-year-old woman was incidentally found to have a visceral artery aneurysm at another hospital and was referred to our hospital. We diagnosed a 20 mm saccular AOB aneurysm by contrast-enhanced computed tomography (CT) and performed endovascular treatment. During the initial treatment, we embolized two outflow arteries with coils. After that, the blood flow to AOB aneurysm and the inflow artery was lost, we concluded the procedure. One week later, the contrast-enhance CT showed that a part of the aneurysm and the inflow artery were recanalized, therefore we performed the second treatment. We performed coil embolization of a part of the aneurysm and the inflow artery. Three months after the procedure, the contrast-enhanced CT showed the aneurysm was completely embolized. It was considered that the endovascular treatment with coil embolization was a safe and effective treatment for AOB aneurysm.