Cystic artery: An anatomic morphological study and its clinical significance

Background Cystic artery is one of the arteries which is of utmost surgical importance, as it originates from the vast range of blood vessels, associated to the coeliac trunk and superior mesenteric artery and its relation to the biliary ducts is variable. Cystic artery is not only difficult to visualize, but difficult to approach during the surgery. This study was undertaken to study the anatomy of arterial variations of cystic artery in the specimens of liver and gallbladder by exploring the extrahepatic duct system, and in addition the relations of cystic artery in the Calot’s triangle were also studied and observed. Materials and Methods The study was conducted on 50 human liver specimens with intact gallbladder and extrahepatic duct system, collected from the Department of Anatomy over a period of 5 years. The specimens obtained were fixed in 10% formalin and were finely dissected. The specimens were observed for parameters like the origin of the cystic artery, its length and diameter, mode and level of termination, relation to the Calot’s triangle, and the extrahepatic duct system. Results Origin of the cystic artery was normal in 92% of cases and variations were seen in approximately 8% cases. The most common origin of the cystic artery was from the right hepatic artery, which was in 92% of the cases. In the present study, in 97% cases the cystic artery terminated by dividing into the superficial and deep branches. In the rest, the artery continued as a superficial branch, the deep branch being replaced by the accessory cystic artery. In 64% cases, the cystic artery was seen within the Calot’s triangle, and in 36% of cases, it was outside the Calot’s triangle. In 67% cases, the cystic artery was medial to the cystic duct, in approximately 63% cases the cystic artery was lateral to the common hepatic duct, and in 30% of the cases the cystic artery passed anterior to the cystic duct. Incidence of accessory cystic arteries in the present study was approximately 4%.