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The clinical anatomy of cystic artery variations: a review of over 9800 cases

Surgical and Radiologic Anatomy volume 38, pages 529–539 (2016)Cite this article

Abstract

Purpose

While laparoscopic cholecystectomy can be a routine procedure when biliary anatomy is normally located, cystic artery variations can easily disorientate the inexperienced surgeon to the anatomy of the hepatobiliary triangle. This study presents the clinically important anatomical variations of the cystic artery.

Methods

PubMed, Medline, Cochrane Database of Systematic Reviews, and Google Scholar databases were searched to conduct a review of the existing English literature on the clinically important cystic artery variations. An aberrant vessel was defined as a vessel that originated from an atypical source and/or one that was present in a specimen in addition to the normal vessel.

Results

The cystic artery originated typically from the right hepatic artery (79.02 %) and was found in the hepatobiliary triangle in only 5427 of 6661 (81.5 %) cases. Clinically important cystic artery variations are (1) the cystic artery located anterior to the common hepatic duct or common bile duct found in 485 of 2704 (17.9 %) and 228 of 4202 (5.4 %) of cases, respectively, (2) the cystic artery located inferior to the cystic duct found in 38 of 770 (4.9 %) of cases, (3) short cystic arteries found in 98 of 1037 (9.5 %) cases and (4) multiple cystic arteries found in (8.9 %) of cases.

Conclusion

These variations are common in the general population and can lead to inadvertent ligation of biliary ducts or aberrant vessels. Therefore, it is important for the hepatobiliary surgeon to be aware of these vascular anomalies to avoid operative complications.

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Acknowledgments

The authors wish to thank Jessica Holland (CMI), MS, Medical Illustrator for the creation of her illustrations used in this publication. The authors also wish to extend their gratitude to the individuals who donated their bodies without whom this review would not have been possible.

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Affiliations

  1. Department of Anatomical Sciences, St. George’s University, School of Medicine, St. George’s, Grenada, West Indies

    R. G. Andall, M. du Plessis, R. S. Tubbs & M. Loukas

  2. Department of Anatomy, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania

    P. Matusz

  3. Department of Radiology, Tufts Medical School, Boston, MA, USA

    R. Ward

  4. Pediatric Neurosurgery, Children’s Hospital, Birmingham, AL, USA

    R. S. Tubbs

Authors
  1. R. G. Andall
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  2. P. Matusz
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  3. M. du Plessis
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  4. R. Ward
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  5. R. S. Tubbs
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  6. M. Loukas
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Correspondence to M. Loukas.

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All authors declare that there are no financial associations and no conflict of interest.

Ethical considerations

This study used already publicly available data and is therefore exempt from review by the IRB. The specimens used for images are protected under IRB approval (06014) as issued by St. George’s University.

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Andall, R.G., Matusz, P., du Plessis, M. et al. The clinical anatomy of cystic artery variations: a review of over 9800 cases. Surg Radiol Anat 38, 529–539 (2016). https://doi.org/10.1007/s00276-015-1600-y

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  • DOI: https://doi.org/10.1007/s00276-015-1600-y

Keywords

  • Hepatic artery abnormalities
  • Double cystic arteries
  • Inferior cystic artery
  • Calot’s triangle
  • Hepatobiliary triangle
  • Gall bladder blood supply