title: The clinical anatomy of cystic artery variations: a review of over 9800 cases.
abstract: OBJECTIVE
  While laparoscopic cholecystectomy can be a routine procedure when biliary anatomy is normally located, cystic artery variations can easily disorientate the inexperienced surgeon to the anatomy of the hepatobiliary triangle. This study presents the clinically important anatomical variations of the cystic artery.
  
  
  METHODS
  PubMed, Medline, Cochrane Database of Systematic Reviews, and Google Scholar databases were searched to conduct a review of the existing English literature on the clinically important cystic artery variations. An aberrant vessel was defined as a vessel that originated from an atypical source and/or one that was present in a specimen in addition to the normal vessel.
  
  
  RESULTS
  The cystic artery originated typically from the right hepatic artery (79.02 %) and was found in the hepatobiliary triangle in only 5427 of 6661 (81.5 %) cases. Clinically important cystic artery variations are (1) the cystic artery located anterior to the common hepatic duct or common bile duct found in 485 of 2704 (17.9 %) and 228 of 4202 (5.4 %) of cases, respectively, (2) the cystic artery located inferior to the cystic duct found in 38 of 770 (4.9 %) of cases, (3) short cystic arteries found in 98 of 1037 (9.5 %) cases and (4) multiple cystic arteries found in (8.9 %) of cases.
  
  
  CONCLUSIONS
  These variations are common in the general population and can lead to inadvertent ligation of biliary ducts or aberrant vessels. Therefore, it is important for the hepatobiliary surgeon to be aware of these vascular anomalies to avoid operative complications.
authors.affiliation: Department of Anatomical Sciences, St. George's University, School of Medicine, St. George's, Grenada, West Indies.
authors.forename: R G
authors.initials: RG
authors.lastname: Andall
authors.affiliation: Department of Anatomy, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: P
authors.initials: P
authors.lastname: Matusz
authors.affiliation: Department of Anatomical Sciences, St. George's University, School of Medicine, St. George's, Grenada, West Indies.
authors.forename: M
authors.initials: M
authors.lastname: du Plessis
authors.affiliation: Department of Radiology, Tufts Medical School, Boston, MA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Ward
authors.affiliation: Department of Anatomical Sciences, St. George's University, School of Medicine, St. George's, Grenada, West Indies.|Pediatric Neurosurgery, Children's Hospital, Birmingham, AL, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: Department of Anatomical Sciences, St. George's University, School of Medicine, St. George's, Grenada, West Indies. mloukas@sgu.edu.
authors.forename: M
authors.initials: M
authors.lastname: Loukas
mesh_terms: D063405:Anatomic Variation; D002102:Cadaver; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D000072226:Computed Tomography Angiography; D003549:Cystic Duct / Q000098:blood supply*; D004210:Dissection; D005704:Gallbladder / Q000098:blood supply* / Q000601:surgery; D006499:Hepatic Artery / Q000033:anatomy & histology*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D015995:Prevalence
keywords: Calot’s triangle; Double cystic arteries; Gall bladder blood supply; Hepatic artery abnormalities; Hepatobiliary triangle; Inferior cystic artery