Saad Wael E A, Davies Mark G, Sahler Lawrence, Lee David, Patel Nikhil, Kitanosono Takashi, Sasson Talia, Waldman David
Section of Cardiovascular and Interventional Radiology, Center for Vascular Disease, Department of Radiology, University of Rochester Medical Center, Rochester, NY 14642, USA.
Vasc Endovascular Surg. 2005 Jul-Aug;39(4):347-9. doi: 10.1177/153857440503900407.
The purpose of this study was to determine the incidence and diameter of the Arc of Buhler by power injection digital subtraction angiography in asymptomatic patients. A retrospective evaluation of 120 combined celiac (CAx) and superior mesenteric artery (SMA) angiograms was carried out on potential live related liver transplant donors (asymptomatic patients) performed from January 1999 to May 2002. The diameter of the Arc of Buhler was calculated with reference to the 5 French catheters used to perform the diagnostic angiograms. It was considered hemodynamically significant if it preferential filled the branches of the other visceral vessel. An Arc of Buhler was identified in 4 patients (3.3%). All 4 patients had a patent gastroduodenal artery (GDA) and none of the 4 had a hemodynamically significant stenosis of either the SMA or the CAx. All Arcs of Buhler found measured less than 2.5 mm in diameter and half of them (2 of the 4) filled the CAx when power injecting the SMA and/or vice versa. There is a low incidence of Arc of Buhler in asymptomatic patients; however, 50% of those encountered were hemodynamically significant. When evaluating the Arc of Buhler by angiography in the setting of pathology, it is important to have a reference diameter and hemodynamic reference in the normal setting, particularly when the prospect of GDA ligation or embolization is entertained in the presence of CAx or SMA occlusion.
本研究的目的是通过能量注射数字减影血管造影术确定无症状患者布勒尔弓的发生率和直径。对1999年1月至2002年5月期间进行的潜在活体亲属肝移植供体（无症状患者）的120例腹腔干（CAx）和肠系膜上动脉（SMA）联合血管造影进行了回顾性评估。布勒尔弓的直径是参照用于进行诊断性血管造影的5F导管计算得出的。如果它优先充盈另一内脏血管的分支，则认为具有血流动力学意义。在4例患者（3.3%）中发现了布勒尔弓。所有4例患者的胃十二指肠动脉（GDA）均通畅，且这4例患者中无一例SMA或CAx存在血流动力学意义上的狭窄。所有发现的布勒尔弓直径均小于2.5mm，其中一半（4例中的2例）在能量注射SMA时充盈CAx，和/或反之亦然。无症状患者中布勒尔弓的发生率较低；然而，所发现的患者中有50%具有血流动力学意义。在病理情况下通过血管造影评估布勒尔弓时，在正常情况下有一个参考直径和血流动力学参考很重要，特别是当在存在CAx或SMA闭塞的情况下考虑结扎或栓塞GDA时。
