Sugihara Fumie, Murata Satoru, Uchiyama Fumio, Watari Jun, Tajima Hiroto, Kumita Shin-Ichiro
Department of Radiology, Nippon Medical School, IVR Center.
J Nippon Med Sch. 2016;83(5):196-198. doi: 10.1272/jnms.83.196.
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.
在本报告中，我们描述了一例布勒氏弓（AOB）无症状动脉瘤患者，该患者通过经导管动脉栓塞术成功治愈。患者表现为腹腔干严重狭窄，怀疑是由正中弓状韧带综合征所致。肠系膜上动脉造影显示AOB处动脉瘤内血流湍急。因此，使用可脱性弹簧圈和微弹簧圈谨慎地进行了栓塞。栓塞后进行的动脉造影未显示任何动脉瘤，且可通过源自肠系膜上动脉的胰弓检测到肝动脉和脾动脉。AOB是肠系膜上动脉与腹腔动脉之间持续存在的胚胎腹侧吻合支。这条吻合动脉独立于胃十二指肠动脉和胰背动脉，极为罕见，发生率<4%。AOB动脉瘤更为少见，此类病例曾有与腹腔干狭窄或闭塞相关的报道。开放性手术动脉瘤切除术，无论是否进行重建，是此类动脉瘤的传统治疗方法。然而，介入放射学的迅速发展使得通过经导管动脉栓塞术能够安全有效地治疗内脏动脉瘤。基于目前的研究结果，我们认为经导管动脉栓塞术是一种微创且有价值的方法，可作为AOB动脉瘤的初始治疗选择。
