Arc of Buhler pseudoaneurysm complicated by an arterioportal fistula: a combined endovascular and open surgical approach.

The Arc of Buhler (AoB) is a rare anatomic variant characterized by direct anastomosis between the celiac artery and the superior mesenteric artery. There is a relative paucity of data regarding this anatomy, likely due to its rather low incidence. The most common pathology associated with AoB is aneurysm formation, and while AoB aneurysm is exceedingly rare, a pseudoaneurysm appears even more so. We present a case of an AoB pseudoaneurysm in a 62-year-old male which was complicated by an arterioportal fistula (APF) between the pseudoaneurysm and the main portal vein. A multidisciplinary team of surgeons, interventional radiologists, and body radiologists worked together to treat this complex pathology. To our knowledge, this is the first reported case of an AoB pseudoaneurysm with an APF. This case emphasizes the importance of multispecialty collaboration in treating such unusual and complex vascular pathology.