Presentation
Abdominal angina with episodes of postprandial pain and diarrhea
Patient Data
Extensive calcified atherosclerosis with high-grade ostial stenosis of both the celiac trunk and superior mesenteric artery as well as high-grade bilateral renal artery stenosis with secondary renal parenchymal atrophy. A prominent patent arc of Buhler artery is present and supplies collateral circulation between the celiac trunk and superior mesenteric artery.
Thick-slab maximum intensity projection (MIP) nicely demonstrates the presence of the arc of Buhler artery (annotated) which provides collateral circulation between the celiac trunk and superior mesenteric artery.
Case Discussion
The arc of Buhler artery is only present in 1-4% of individuals. This anatomical variant is of clinical importance in patients with intestinal angina as a result of arterial stenosis as it provides an additional collateral pathway between the celiac trunk and superior mesenteric vascular territory. This case nicely demonstrates high-grade stenosis of both the celiac trunk and superior mesenteric artery resulting in chronic mesenteric ischemia with a prominent arc of Buhler allowing collateral arterial flow and thereby preventing acute infarction.