Anatomical variations of cystic artery: A digital subtraction angiography study

Authors

Keywords:

Cystic artery, Michel's classification, Digital substraction angiography, Variation

Abstract

Background/Aim: Branching variations in the cystic and hepatic arteries may lead to bleeding and mortal complications during surgery. This study aimed to demonstrate the relationship between cystic artery (CA) variations and hepatic artery branching patterns among an Anatolian population using Michel’s classification and compare the distribution of these variations among genders. Methods: Angiographies performed between 2014-2017 were retrospectively evaluated and DSA images of 303 patients (84 females and 219 males) were included in this cross-sectional study. Michel’s classifications of the hepatic arteries and CA variations of the patients were noted, and each was analyzed separately, along with gender-related branching differences. Results: Hepatic arteries of 256 patients could be evaluated according to Michel’s classification, the most frequent being Michel’s class I (69.9 %). Thirty patients (9.9%) were excluded from CA-related statistical analyses since they had undergone a cholecystectomy. CAs were not visualized in fifty-five (18.2%) of the remaining patients. Of the 218 patients with apparent CAs, eleven females (19.3%) and twenty males (12.4%) had double cystic arteries (P=0.201). Two hundred and twelve (85.1%) CAs originated from the right hepatic artery (RHA), which was the most common parent artery. No significant relationship was found between Michel’s classification and CA origin among different genders (P=0.532). Conclusion: An overlooked anatomic variation could lead to many iatrogenic complications during diagnostic and therapeutic interventions; thus, variations of the vascular structures have attracted medical professionals’ interest. This study focuses on the variations of the cystic artery and its relationship with hepatic arterial branching variations.

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References

Standring S. Gray’s anatomy: the anatomical basis of clinical practice, Churchill Livingstone Spain: Elsevier; 2008. p.1169.

Michels NA. The hepatic, cystic, and retroduodenal arteries and their relations to the biliary ducts:with samples of the entire celiacal blood supply. Ann Surg. 1951;133(4):503–24. doi: 10.1097/00000658-195104000-00009.

Noussios G, Dimitriou I, Chatzis I, Katsourakis A. The main anatomic variations of the hepatic artery and their importance in surgical practice: Review of the literature. J Clin Med Res. 2017;9(4):248-52. doi: 10.14740/jocmr2902w.

Sabaa L, Mallarini G. Multidetector row CT angiography in the evaluation of the hepatic artery and its anatomical variants. Clinical Radiology. 2008;63(3):312-21. doi: 10.1016/j.crad.2007.05.023.

Priyadharshini S, Bharath CV, Bapuji P, Nagaguhan V. A study on variations in origin and course of right hepatic artery. Int J Anat Res. 2020;8(1.1):7207-11. doi: 10.16965/ijar.2019.340.

Mugunthan N, Kannan R, Jebakani CF, Anbalagan J. Variations in the origin and course of right hepatic artery and its surgical significance. J Clin Diagn Res. 2016;10(9):AC01-4. doi: 10.7860/JCDR/2016/22126.8428.

Komatsu T, Matsui O, Kadoya M, Yoshikawa J, Gabata T, Takashima T. Cystic artery origin of the segment V hepatic artery. Cardiovasc Intervent Radiol. 1999;22(2):165–7. doi: 10.1007/s002709900357.

Mlakar B, Gadzijev EM, Ravnik D, Hribernik M. Anatomical variations of the cystic artery. Eur J Morphol. 2003;41(1):31–4. doi: 10.1076/ejom.41.1.31.28103.

Saylısoy S, Atasoy C, Ersöz S, Karayalçın K, Akyar S. Multislice CT angiography in the evaluation of hepatic vascular anatomy in potential right lobe donors. Diagn Interv Radiol. 2005;11(1):51-9.

Ugurel MS, Battal B, Bozlar U, Nural MS, Tasar M, Ors F, et al. Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. Br J Radiol. 2010;83(992):661–7. doi: 10.1259/bjr/21236482.

Du D, Wang Y, Wang X, Ma M, Gao J, Rong Z, et al. Hepatic artery variations analyzed in 1141 patients undergoing digital subtraction angiography. Research Square. 2021. doi: 10.21203/rs.3.rs-218499/v1.

Andall RG, Matusz P, Plessis MD, Ward R, Tubbs RS, Loukas M. The clinical anatomy of cystic artery variations: a review of over 9800 cases. Surg Radiol Anat. 2016;38(5):529-39. doi:10.1007/s00276-015-1600-y.

Rashid A, Mushtaque M, Bali RS, Nazir S, Khuroo S, Ishaq S. Artery to cystic duct: A consistent branch of cystic artery seen in laparoscopic cholecystectomy. Anat Res Int. 2015;2015:847812. doi: 10.1155/2015/847812.

Xia J, Zhang Z, He Y, Qu J, Yang J. Assessment and classification of cystic arteries with 64-detector row computed tomography before laparoscopic cholecystectomy. Surg Radiol Anat. 2015;37(9):1027–34. doi: 10.1007/s00276-015-1479-7.

Aydın OU, Tihan ND, Sabuncuoğlu MZ, Dandin Ö, Yeğen FS, Balta AZ, et al. Assessment of lateral to medial dissection of Calot’s triangle in laparoscopic cholecystectomy: A case-control study. J Surg Med. 2018;2(1):27-31. doi: 10.28982/josam.388093.

Ding YM, Wang B, Wang WX, Wang P, Yan JS. New classification of the anatomic variations of cystic artery during laparoscopic cholecystectomy. World J Gastroenterol. 2007;13(42):5629–34. doi: 10.3748/wjg.v13.i42.5629.

Fathy O, Zeid MA, Abdallah T, Fouad A, Eleinien AA, el-Hak NG, et al. Laparoscopic cholecystectomy: a report on 2000 cases. Hepatogastroenterology. 2003;50(52):967–971.

Kang B, Kim HC, Chung JW, Hur S, Jae HJ, Park JH. The Origin of the Cystic artery supplying hepatocellular carcinoma on digital subtraction angiography in 311 patients. Cardiovasc Intervent Radiol. 2014;37(5):1268–82. doi: 10.1007/s00270-013-0773-1.

Bakheit MA. Prevalence of variations of the cystic artery in the Sudanese. East Mediterr Health J. 2009;15(5):1308-12.

Saidi H, Karanja TM, Ogengo JA. Variant anatomy of the cystic artery in adult Kenyans. Clin Anat. 2007;20(8):943–5. doi: 10.1002/ca.20550.

Dandekar U, Dandekar K. Cystic artery: Morphological study and surgical significance. Anat Res Int. 2016; 2016:7201858. doi: 10.1155/2016/7201858.

Hlaing KPP, Thwin SS, Shwe N. Unique origin of the cystic artery. Singapore Med J. 2011;52(12): e262-4.

Ding YM, Wang B, Wang WX, Wang P, Yan JS. New classification of the anatomic variations of cystic artery during laparoscopic cholecystectomy. World J Gastroenterol. 2007;13(42): 5629-34. doi: 10.3748/wjg.v13.i42.5629.

Chen TH, Shyu JF, Chen CH, Ma KH, Wu CW, Lui WY, et al. Variations of the cystic artery in Chinese adults. Surg Laparosc Endosc Percutan Tech. 2000;10(3):154–7. doi: 10.1097/00019509-200006000-00011.

Balija M, Huis M, Nikolic V, Stulhofer M. Laparoscopic visualization of the cystic artery anatomy. World J Surg. 1999;23(7):703-7. doi: 10.1007/pl00012372.

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Published

2021-04-01

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Research Article

How to Cite

1.
Çelebioğlu EC, Akkaşoğlu S. Anatomical variations of cystic artery: A digital subtraction angiography study. J Surg Med [Internet]. 2021 Apr. 1 [cited 2024 Mar. 29];5(4):358-61. Available from: https://jsurgmed.com/article/view/924359