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Artery: Cystic artery
The cystic artery branches from the hepatic artery proper. The hepatic artery proper (also proper hepatic artery) arises from the Common hepatic artery and runs alongside the Portal vein and the Common bile
Relationship to other vessels. (Note that relationships are highly variable -- see below. )
Latin arteria cystica
Gray's subject #154 605
Supplies Gall bladder and cystic duct
Source Right hepatic artery   
Branches Superior branch
Deep branch
Vein Cystic vein
Dorlands
/ Elsevier    		 a_61/12154087

The cystic artery supplies oxygenated blood to the gallbladder and cystic duct. Latin ( lingua Latīna, laˈtiːna is an Italic language, historically spoken in Latium and Ancient Rome. The gallbladder (or cholecyst sometimes gall bladder is a small organ whose function in the body is to store Bile and aid in the digestive process The cystic duct is the short Duct that joins the Gall bladder to the Common bile duct. The cystic vein drains the blood from the Gall-bladder, and accompanying the Cystic duct, usually ends in the right branch of the portal vein. Elsevier, the world's largest Publisher of Medical and Scientific literature, forms part of the Reed Elsevier group The gallbladder (or cholecyst sometimes gall bladder is a small organ whose function in the body is to store Bile and aid in the digestive process The cystic duct is the short Duct that joins the Gall bladder to the Common bile duct.

Contents

Most common arrangement

In the classic arrangement, occurring with a frequency of approximately 70%, a singular cystic artery originates from the geniculate flexure of the right hepatic artery in the upper portion of the hepatobiliary triangle [1]. The hepatic artery proper (also proper hepatic artery) arises from the Common hepatic artery and runs alongside the Portal vein and the Common bile The hepatobiliary triangle (or cystohepatic triangle) is an anatomic space bordered by the Common hepatic duct medially the Cystic duct inferiorly and A site of origin from a more proximal or distal portion of the right hepatic artery is also considered relatively normal.

After separating from the right hepatic artery, the cystic artery travels superiorly to the cystic duct and produces 2 to 4 minor branches, known as Calot’s arteries, that supply part of the cystic duct and cervix of the gallbladder before dividing into the major superficial and deep branches at the superior aspect of the gallbladder neck:

Anatomic variation

Double cystic artery

When superficial and deep branches of the cystic artery do not share a common origin it is defined as a double cystic artery occurring with a frequency of 15%.

The deep branch consistently arises from the right hepatic artery which is generally also the source of origin of the superficial branch, however in some cases it has been found to initiate from the anterior segmental artery, middle hepatic artery, left hepatic artery, superior mesenteric artery, gastroduodenal artery or retroduodenal artery. See also Superior Mesenteric Artery Syndrome In Human anatomy, the superior mesenteric artery (SMA arises from the anterior surface of the Abdominal aorta In Anatomy, the gastroduodenal artery is a small Blood vessel in the Abdomen.

Approximately half of superficial cystic arteries have been shown to enter through the hepatobiliary triangle, while deep cystic arteries are often quite small in length and diameter. Tripling of the cystic artery is very rare, occurring in between 0-0. 3% of cases.

Aberrant origin of the right hepatic artery

Unusual anatomy of the right hepatic can itself affect the path and form of the cystic artery, with the most frequent variation resulting from an aberrant origin of the right hepatic artery which is described in between 2-16% of cases.

Generally this anomalous source is the superior mesenteric artery or more rarely the abdominal aorta, producing what has been described as a “replacing right hepatic artery”, passing through the hepatobiliary triangle and running posterior and parallel to the cystic duct [2].

Because of the close proximity to the gallbladder to the (replacing) right hepatic artery a “caterpillar” or “Moynihan's” hump may form and this artery generally produces multiple short cystic branches rather than a single cystic artery [3].

Left hepatic artery

The cystic artery can arise from the left hepatic artery, and in such a case it usually travels through a passage of liver parenchyma, approaching the neck of the gallbladder, before bifurcating into ascending (or superior) and descending (or inferior) branches. Parenchyma is a term used to describe a bulk of a substance It is used in different ways in Animals and in Plants. This situation is found in roughly 1% of cases.

This form of the cystic artery does not pass through the hepatobiliary triangle and has been found located both anteriorly and posteriorly to the common hepatic duct. [1]

Recurrent cystic artery

In less than 1% of patients a form known as a recurrent cystic artery is found – the cystic artery arises from the left hepatic artery and passes through either the cholecystoduodenal or cholecystocolic ligaments (connecting the gallbladder to the duodenum and transverse colon respectively), follows the right edge of the hepatoduodenal ligament, and connects to the fundus of the gallbladder before descending to supply the body and neck. The hepatoduodenal ligament is the portion of the Lesser omentum extending between the Porta hepatis of the Liver and the first part of the Duodenum [1]

Low-lying cystic artery

When a single cystic artery arises from gastroduodenal artery it forms a configuration is known as low-lying cystic artery, as it passes inferior to the cystic duct through the cholecystoduodenal ligament, and therefore remains outside the hepatobiliary triangle. [1]

This condition has alternatively been described as an inferior cystic artery and transposition of the cystic artery and duct with a prevalence at approximately 5%.

In 25% of these patients with this course there will be a secondary arterial supply to the gallbladder, with the low-lying artery acting as the equivalent of the posterior branch. [3]

Clinical significance

It must be identified and ligated in operations that remove the gallbladder (cholecystectomies). Cholecystectomy (/ˌkɔləsɪsˈtɛktəmi/ plural cholecystectomies is the surgical removal of the Gallbladder.

References

  1. ^ a b c d Balija M, Huis M, Nikolic V, Stulhofer M. Laparoscopic visualization of the cystic artery anatomy. World J Surg. 1999 Jul;23(7):703-7. PMID 10390590
  2. ^ Mlakar Bostjan, Gadzijev Eldar M, Ravnik Dean, Hribernik Marija. Anatomical Variations of the Cystic Artery. Eur J Morph. 2003; 41: 31-34. PMID 15121546
  3. ^ a b Hugh Thomas B, Kelly Michael D, Li Bei. Laparoscopic Anatomy of the Cystic Artery. Am J Surg. 1992; 163: 393-395. PMID 1534464

External links

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