Prevalence of anatomical variations of cystic artery in South Indian cadavers

Tejaswi HL, Dakshayani KR, Ajay N

Abstract


Background: The knowledge of variations in the origin and course of cystic artery is important for the surgeons as uncontrolled bleeding from the cystic artery and its branches can be fatal during cholecystectomy. Intra operative bleeding can result in an increase in the risk of intra operative injury to vital vascular and biliary structures. Keeping in view the clinical significance and applied importance of the cystic artery anatomy and to add some more knowledge to the existing ones, the present study was undertaken, to know in detail the level of origin, length, and variations in the course and relation of the cystic artery.

Methods: The present study was performed on 100 human liver specimens with intact gallbladder and extrahepatic duct system, obtained after dissection from the cadavers in the Department of Anatomy and from post-mortem cases from the Department of Forensic Medicine, Mysore Medical College and Research Institute, Mysore, over a period of 18 months.

Results: Most common source of origin of the cystic artery was the right hepatic artery in 92 cases (92%) followed by aberrant right hepatic artery in 4 cases (4%) and the least common sources observed were the left hepatic artery in 1 case (1%) and the gastroduodenal artery in 1 case (1%).Mean length of the cystic artery was 17.6 mm and ranged between 3.7 mm to 42 mm. Out of the 100 dissected specimens, in 65 (65%) the cystic artery was found inside the Calot’s triangle and in 35 (35%) outside the triangle.

Conclusion: This study provides details of the normal as well as the variant anatomy of the cystic artery, knowledge of which is very essential for the surgeons to minimize the risk of injury to the blood vessels and the biliary apparatus during cholecystectomy.

 


Keywords


Cystic artery, Gall bladder, Variations, Cholecystectomy, Calot’s triangle

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References


Abdomen. In: Moore KL, Dalley AF, Agur AMR, eds. Clinically oriented anatomy. 6th ed. Philadelphia, PA: Lippincot William and Wilkins; 1999:279.

Borley NR. Gall bladder and biliary tree. In: Standring S, Ellis H, Healy JC, Johnson D, Williams A, Collins P, et al. Gray’s Anatomy, The anatomical basis of clinical practice. 40th ed. New York: Elsevier Churchill Livingstone; 2005:1178-1180.

Nagral S. Anatomy relevant to cholecystectomy. J Min Access Surg 2005; 1(2):53-8.

Romanes GJ. Cunningham’s Manual of practical anatomy. 15th ed. Thorax and Abdomen. New York: Oxford University Press; 2007. 2:125.

Flisinski P, Szpinda M, Flisinski M. The cystic artery in human fetuses. Folia Morphol 2004;63(1):47-50.

Flint ER. Abnormalities of the right hepatic, cystic and gastroduodenal arteries and of the bile ducts. Br J Surg 1923;10:509-19.

Daseler EH, Anson BJ, Hambley WC, Reimann AF. The cystic artery and constituents of the hepatic pedicle. Surg Gynecol Obst 1947;85:47-63.

Michels NA. Blood supply and anatomy of the upper abdominal organs. 1st ed. London: Pitman; 1956. pp. 32-73.

DeSilva M, Fernando D. Anatomy of the Calot’s triangle and its relevance to laparoscopic cholecystectomy. Ceylon Med J 2001;46(1):33-4.

Khalil M, Sultana ZR, Rahman HR, Sultana SZ, Mannan S, Rahman MM, et al. Origin and position of cystic artery in Bangladeshi corpse. J Bangladesh Soc Physiol 2008 Dec;3:66-70.

Pushpalatha K, Shamsundar NM. Variation in the origin of cystic artery. J Anat Soc India 2010;59(1): 35-7.

Michels NA. Variational anatomy of the hepatic, cystic and retroduodenal arteries. A statistical analysis of their origin, distribution and relations to the biliary ducts in two hundred bodies. Arch Surg 1953;66:20-34.

Futara G, Ali A, Kinfu Y. Variations of the hepatic and cystic arteries among Ethiopians. Ethiop Med J 2001 Apr;39(2):133-42.