Cystic artery

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Artery: Cystic artery
The cystic artery branches from the hepatic artery proper.
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

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The cystic artery supplies oxygenated blood to the gallbladder and cystic duct.

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]. 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:

• The superficial branch (or anterior branch) passes sub-serously over the left aspect of the gallbladder.
• The deep branch (or posterior branch) runs between the gallbladder and gallbladder fossa, terminating at the peritoneum attached to the liver surface.

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.

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 ^[1].

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 ^[1].

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. 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.^[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.^[1]

Clinical significance

It must be identified and ligated in operations that remove the gallbladder (cholecystectomies).

Reference

External link

• Cystic artery - thefreedictionary.com
• Cystic+artery at eMedicine Dictionary
• SUNY Anatomy Image 8331
• SUNY Anatomy Image 7967
• Norman/Georgetown celiactrunk
• Norman/Georgetown liver (biliarysystem)

v • d • e Arteries of torso - abdomen
AA: Anterior	celiac left gastric splenic: pancreatic branches (arteria pancreatica magna) – short gastric – left gastro-omental common hepatic: proper hepatic (cystic), right gastric, gastroduodenal (right gastro-omental, superior pancreaticoduodenal) SMA inferior pancreaticoduodenal – intestinal – ileocolic (appendicular) – right colic – middle colic IMA left colic – sigmoid – superior rectal – marginal
AA: Posterior	visceral: middle suprarenal – renal (inferior suprarenal) – testicular/ovarian parietal: inferior phrenic (superior suprarenal) – lumbar – median sacral terminal: common iliac (IIA, EIA)
IIA: Anterior	umbilical (superior vesical, to ductus deferens) – inferior vesical – middle rectal – uterine (azygos of the vagina) – vaginal – obturator (anterior branch, posterior branch) – internal pudendal (inferior rectal, perineal, artery of the urethral bulb, urethral, deep artery of the penis, dorsal artery of the penis) – inferior gluteal (accompanying of ischiadic nerve, crucial anastomosis)
IIA: Posterior	iliolumbar – lateral sacral – superior gluteal
EIA	inferior epigastric (cremasteric) – deep circumflex iliac

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .