Surgical repair of an aneurysm of the Arc of Buhler in a patient with von Recklinghausen's disease.

Introduction attenuated coehac axis with enlarged retroperitoneal collaterals from the SMA and a large, partially calcified, In 1904, Buhler first described an embryologic remnant bilobate aneurysm of unclear origin (Fig. 1). Anglothat represented an anastomosis between the coehac graphy revealed an extremely small calibre coeliac artery and superior mesenteric artery (SMA). 1 This artery with an atretic channel. The artery of Buhler remnant, or "Arc of Buhler", may enlarge to become was demonstrated from the proximal portion of a a major collateral in the presence of coeliac axis ocwidely patent SMA to the dmtal coeliac trunk reclusion. To our knowledge, we report only the second constituting an enlarged, tortuous splenic artery and aneurysm of the Arc of Buhler in the English literature small calibre hepatic and left gastric arterms. Arismg between 1966 and 1997, as well as the only one resected near the origin of the artery of Buhler was a threeand revascularized. It is also the first reported m lobulated aneurysmwith one area of calcification (Fig. associahon with neurofibromatosis, a disease as2). No other visceral aneurysms were noted and the soclated with visceral artery aneurysms. Treatment left renal artery was normal. options for visceral aneurysms, including the aortoAt operation the retroperitoneum was entered and splenic artery graft with autogenous veto that we the root of the mesentery exposed, a large multidescribe, are discussed, lobular aneurysm was immediately encountered (Fig. 3a). The afferent and efferent arteries, which appeared to be in continuity with the superior mesenteric artery