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 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.
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 .
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 .
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.
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.
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