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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Variations in Origin of Cystic Artery.

Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System

Variations in Origin of Cystic Artery.

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed


Image of variations in origin of cystic artery

ALH, accessory left hepatic artery; ARH, accessory right hepatic; C, cystic; CA, celiac (axis); GD, gastroduodenal; LG, left gastric; LH, left hepatic; RG, right gastric; RH, right hepatic; RRH, replacing right hepatic; S, splenic; SM, superior mesenteric.

In addition to the origins shown here, the authors found that the cystic artery also arose in three instances from an accessory or a replacing type of right hepatic artery which arose from the celiac trunk. (Number of specimens, 500.)

Daseler et al. provide the following summary:
Origin of cystic artery; 580 cases: right division of regular hepatic, 416; right hepatic from superior mesenteric, 90; left hepatic, 36; common hepatic, 16; gastrocluodenal, 15; replacing or accessory right hepatic, 3; celiac, 2; superior mesenteric, 1; superior pancreaticoduodenal, 1.

Origin of accessory cystic artery; 65 cases: right hepatic, 50; gastroduodenal, 6; common hepatic, 4; left hepatic, 3; accessory right hepatic from superior mesenteric, 2.

Origin of single replacing cystic artery; 120 cases: replacing right hepatic from superior mesenteric, 36; left hepatic, 27; right hepatic from replacing common hepatic, 21; accessory right hepatic from superior mesenteric, 12; common hepatic, 11; gastrocluodenal, 6; accessory right hepatic from celiac, 3; celiac, 2; superior mesenteric, 1 ; superior pancreaticoduodenal, 1.

Origin of dual replacing cystic arteries, 15 cases: both from right hepatic branch of superior mesenteric, 7; replacing right hepatic and left hepatic, 3; both from left hepatic, 1; gastroduodenal and accessory right hepatic, 1; gastroduodenal and right hepatic branch from celiac, 1; gastroduodenal and left hepatic, 1; gastrocluodenal and right hepatic branch of superior mesenteric, 1.

Location of cystic artery; 580 vessels: *Chalot's triangle, 405; anterior to common hepatic duct, 123; anterior to common bile duct, 17; posterior to common hepatic duct, 12; between hepatic ducts, 6; anterior to cystic duct and right hepatic duct, 6; right of duct system, 5; posterior to common bile duct, 3; left of duct system, 2; posterior to cystic duct and right hepatic duct, 1.

Authors' note: *Chalot's triangle is formed by the common hepatic and cystic ducts.

Redrawn from Daseler, E.H., Anson, B.J., Hambley, WC. and A.F. Reimann. The cystic artery and constituents of the hepatic pedicle. A study of 500 specimens. Surg. Gynecol. Obstet 85:47-63, 1947.

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