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Arc of Bühler: the surgical significance of a rare anatomical variation

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Abstract

Purpose

The arc of Bühler, an anastomotic vessel between celiac artery and superior mesenteric artery, is a rare anatomic variation. Various radiologic and surgical procedures can be affected by its existence. We aim to review all available information and identify possible clinical implications.

Methods

A systematic review was conducted in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. The following terms were utilized in various combinations: “Bühler”, “arc of Bühler”, “visceral aneurysm”, “pancreaticoduodenal arcades”.

Results

Only 53 cases have been described until today in the literature. The arc of Bühler enhances collateral circulation between celiac artery and superior mesenteric artery alongside with pancreaticoduodenal arcades and dorsal pancreatic artery. Computerized tomography and angiography are the main studies used for its detection and evaluation. Aneurysms of Bühler’s arc have been rarely described and seem to share common pathophysiological mechanisms with aneurysms of the pancreaticoduodenal arcades.

Conclusions

Various radiologic and surgical procedures such as embolization or pancreaticoduodenectomy are potentially affected by its existence.

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Authors and Affiliations

  1. Department of Anatomy and Surgical Anatomy, School of Medicine, National and Kapodistrian University of Athens, Tetrapoleos 18, 75 Mikras Asias Str, 11527, Athens, Greece

    Adamantios Michalinos, Dimitrios Filippou & Theodore Troupis

  2. 1st Department of Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Tetrapoleos 18, 11527, Athens, Greece

    Dimitrios Schizas

  3. Department of Surgery, European University of Cyprus, Diogenis Str 6, 2404, Nicosia, Cyprus

    Dimitrios Ntourakis

Authors
  1. Adamantios Michalinos
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  2. Dimitrios Schizas
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  3. Dimitrios Ntourakis
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  4. Dimitrios Filippou
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  5. Theodore Troupis
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Contributions

AM: Project development, data collection, data analysis, manuscript writing. DS: Data collection, data analysis. DN: Data collection, data analysis. DF: Data analysis, writing. TT: Data analysis, manuscript writing, critical editing, general overview.

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Correspondence to Theodore Troupis.

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Michalinos, A., Schizas, D., Ntourakis, D. et al. Arc of Bühler: the surgical significance of a rare anatomical variation. Surg Radiol Anat 41, 575–581 (2019). https://doi.org/10.1007/s00276-018-2168-0

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  • DOI: https://doi.org/10.1007/s00276-018-2168-0

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