Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.200045
Jornal Vascular Brasileiro
Case Report

Arc of Buhler: A lifesaving anatomic variation. A case report

Arco de Buhler: uma variação anatômica que salva vidas – relato de caso

Schizas Nikolaos; Patris Vasilios; Lama Niki; Eleftherios Orestis Argyriou; Kratimenos Theodoros; Argiriou Mihalis

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Abstract

Abstract: The presence of malperfusion syndrome in cases of complicated acute type B aortic dissection is a negative predictive factor and urgent intervention is indicated. Anatomic variations, such as the Arc of Buhler, contribute anastomotic channels and can preserve the visceral blood supply. In this case report, we describe the overall management of a 54-year-old man who presented with a type B aortic dissection. Initially, conservative management was chosen, as indicated for an uncomplicated type B dissection, but the dissection deteriorated. Despite the fact that severe occlusion of the celiac artery was detected on Computed Tomography (CT) angiography, the Arc of Buhler anatomical variation was present, contributing adequate visceral blood supply. After considering this finding, the patient was treated effectively with thoracic endovascular aortic repair (TEVAR).

Keywords

complicated type B aortic dissection, visceral malperfusion, celiac artery, mesenteric artery, TEVAR

Resumo

Resumo: A presença da síndrome de má perfusão em casos de dissecção aórtica aguda do tipo B complicada é um fator preditor negativo, e uma intervenção urgente é indicada. As variações anatômicas, tais como o arco de Buhler, contribuem como canais anastomóticos e podem preservar o suprimento sanguíneo visceral. Neste relato de caso, descrevemos o manejo geral de um paciente do sexo masculino, de 54 anos, que apresentou uma dissecção aórtica do tipo B. Inicialmente, o manejo conservador foi escolhido, conforme indicado para dissecção do tipo B não complicada, mas a dissecção sofreu deterioração. Apesar de uma oclusão grave da artéria celíaca ter sido detectada na angiotomografia computadorizada, a variação anatômica do arco de Buhler estava presente, contribuindo para o suprimento sanguíneo visceral adequado. Após levar em consideração esse achado, o paciente foi tratado de forma efetiva com reparação endovascular da aorta torácica.
 

Palavras-chave

dissecção aórtica do tipo B complicada, má perfusão visceral, artéria celíaca, artéria mesentérica, TEVAR

References

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Submitted date:
04/30/2020

Accepted date:
08/06/2020

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