PMC5933495_01
Intraoperative aortogram demonstrating retrograde perfusion of celiac axis from superior mesenteric artery through Arc of Buhler (arrowheads). The gastroduodenal artery was ligated before imaging (clips), increasing flow from the proximal SMA to the celiac artery through the arc. SMA, superior mesenteric artery.
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After GDA ligation, however, persistent hepatic arterial Doppler signal was appreciated, originating from a presumed SMA collateral vessel on completion of angiography (Fig. 1).
Arterial schematic showing the arc in one of its positions connecting the celiac trunk to the SMA.
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Reanalysis of the preoperative angiography identified the collateral vessel as an Arc of Buhler (Fig. 2).