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Hidden variation of the cystic artery: why does it sometimes arise from the left hepatic artery?
The cystic artery, commonly known as the "single artery", is mainly a tributary of the right hepatic artery and is responsible for supplying arterial blood flow to the gallbladder and providing a certain blood supply to the extrahepatic biliary system. The anatomy of the cystic artery and its variations are of great significance in clinical medicine, especially in surgical procedures such as cholecystectomy.
The diameter of the cystic artery is usually less than 3 mm, and variations in its origin sometimes affect the progress and outcome of surgery.
Anatomy of the cystic artery
Generally speaking, the main source of the cystic artery is the right hepatic artery, and in about 80% of cases, this artery branches from the right hepatic artery. Its course is usually posterior to the gallbladder-hepatic triangle and posterior to the common hepatic duct. When the cystic artery reaches the upper part of the gallbladder neck, it divides into superficial and deep branches. These branches form an arterial network covering the surface of the gallbladder.
Variability of the cystic artery
Anatomically, variability in the cystic artery is very common. In most cases (approximately 70%), the cystic artery branches off a single artery from the right hepatic artery. However, when the superficial and deep branches do not have a common source, this situation is called "double cystic artery" and the probability of occurrence is about 15%. In some rare cases, the cystic artery may arise from other arteries, such as the left hepatic artery, superior mesenteric artery, or other branches.
The abnormal origin and arrangement of the right hepatic artery may affect the direction and shape of the cystic artery, and may even lead to unexpected events during surgery.
Origin of the left hepatic artery
Although the cystic artery originates from the right hepatic artery in most cases, it may also originate from the left hepatic artery in about 1% of cases. In these cases, the cystic artery passes through the liver parenchyma toward the neck of the gallbladder and divides into ascending and descending branches as it approaches the gallbladder. This variant does not pass through the gallbladder-hepatic triangle, but lies anterior or posterior to the common hepatic duct, which may cause difficulties during surgery.
Clinical significance and surgical considerations
When performing cholecystectomy, it is crucial to accurately identify the source of the cystic artery and its blood supply. If not treated correctly it can lead to complications such as bleeding. Therefore, surgeons must be aware of the potential for various variants in order to respond effectively.
During cholecystectomy, the cystic artery must be identified and ligated to avoid unnecessary risks during the operation.
Other variations
In addition to the aforementioned variations, there are other rare variations of the cystic artery, such as the reappearance of the cystic artery, which enters the base of the gallbladder through the ligament that connects the gallbladder to the intestine. The low cystic artery originating from the gastroduodenal artery is found in about 5% of cases and may also affect the method and risk of surgery.
Conclusion
Variations in the cystic artery have profound implications for clinical practice. Understanding its anatomical variations and corresponding assessment of clinical significance will help surgeons perform better operations. When faced with variations in the cystic artery, are we really prepared to account for all possible changes?
