# Prevalence and clinical implications of the rare arc of Bühler using computed tomography angiography and digital subtraction angiography: a systematic review and meta-analysis

## TL;DR

This study finds the arc of Bühler occurs in about 1.9% of people and highlights its importance for surgeons and radiologists to avoid complications during abdominal procedures.

## Contribution

The first systematic review and meta-analysis on the prevalence of the arc of Bühler using CTA and DSA.

## Key findings

- The pooled prevalence of the arc of Bühler is 1.9% across 3,837 patients.
- CTA and DSA show similar prevalence rates of 2.0% and 1.8%, respectively.
- AOB is a rare anatomical variant that can lead to intraoperative complications if not recognized.

## Abstract

Knowledge of the rare arc of Bühler (AOB) is limited but clinically important. At present, there is no publication of systematic review and meta-analysis on AOB in computed tomography angiography (CTA) and digital subtraction angiography (DSA) examinations.

The objective of this study was to evaluate the pooled prevalence and clinical implications of the AOB by using CTA and DSA examinations.

The PubMed, Web of Science, Scopus, Embase, Google Scholar, CBM, CNKI, WanFang, VIP, and Baidu Scholar databases were comprehensively searched for AOB-related literature. Stata 17.0 software was used to conduct the meta-analysis.

Eleven publications with 3,837 patients and 65 AOB cases were included. The pooled prevalence of AOB was 1.9% (95% confidence interval: 0.8–3.2%). CTA showed a pooled prevalence of AOB of 2.0% (95% confidence interval: 0.5–4.3%) and DSA showed a pooled prevalence of AOB of 1.8% (95% confidence interval: 0.5–3.9%).

AOB is a rare anatomical variant, with a pooled prevalence of 1.9% in the general population. General surgeons, vascular surgeons, and interventional radiologists should consider its existence when performing relevant abdominal procedures to avoid intraoperative difficulties, visceral organ ischemia or bleeding, and other complications.