**2. Types of cystic artery and its variation**

### **2.1 Single cystic artery**

The cystic artery commences within the Calot's triangle and most often starting from the right hepatic artery. When getting close to the gallbladder, it bifurcates into deep and superficial branches to the gallbladder neck. The exterior branch proceeds eventually left facet of the gallbladder. The deep branch goes throughout the connective tissues between gallbladder and liver parenchyma. The deep branch engenders really small offshoots to furnish the gallbladder, which anastomoses with all the superficial branches [4]. During open cholecystectomy, such type of CA is laterally located through the cystic duct within Calot's triangle. However in LC procedure, it is merely at the back and a bit much deeper contrary to cystic duct [4]. In a study, such type of variations were documented (73.3%) in 440 of 600 patients [4]. The intricate anatomical deviation among cystic arteries might increase the likelihood of injury throughout LC procedure [5]. Yet in another research, CT images had been analyzed prior to LC, were compared with intra-operative findings and postoperative results. It was witnessed that, cystic artery originating from the right hepatic artery were (76%) in most of the cases, while 55 (60%), CA originating from the right hepatic artery and it undergoes the Calot's triangle and reached the neck of the gallbladder in total of the 91 cases [5]. A single artery to cystic duct together with the conventional configuration of "H shaped" was revealed in 161 (91.47%) patients [6]. Within a current overview of 9800 patients, It is documented that the typical origination of cystic artery were from the RHA (79.02%), where as in 5427 patients (81.5%), origination was found in the hepatobiliary triangle [7]. Variations within cystic artery possessing clinical significance, located anterior to the common hepatic duct in 485 of 2704 patients (17.9%); whereas in 228 (5.4%), out of 4202 patients, located anterior to CBD, correspondingly [7]. A single CA was witnessed in 340 cases out of 740 patients. [8]. Single CA is present in 85% of sufferers out of 300 cases of LC [9]. On standard cholecystectomy, single CA sometimes appears within the hepatobiliary triangle and much more laterally positioned with the cystic duct, although while in laparoscopic view, it could be observed behind and marginally deeper compared to cystic duct [10]. In a recent study by Yang et al., the original source and variety of cystic arteries as well as their relationship together with the Calot's triangle was assessed by CT images and further it was compared with laparoscopic cholecystectomy results. They witnessed single CA was in 53 (73%) of the 73 patients [5]. In one study, normal origin of CA originating from the right hepatic artery was noticed in 72% of patients [11]. In accordance to the reported results, the conventional position of the cystic artery can be found in 70–80% of scenarios [4, 10–12] (**Figure 1A**). Within the study with Kenyan's populations, it had been stated that the CA stood a typical origin from the right hepatic artery in 92.2% of cases, although only one CA supplied the gallbladder within a comparable ratio [13]. With the laparoscopic point of view, a single or a

**125**

*Cystic Artery Variations and Associated Vascular Complications in Laparoscopic Cholecystectomy*

bit larger CA in length necessitates gentle exploration, as it can really be an aberrant hepatic artery, which needs to be dissociated from the cystic duct or gallbladder by

*Schematic illustrations of various anatomic anomalies of cystic artery during LC. (A) Cystic artery origination from right hepatic artery; (B) double cystic artery origination from right hepatic artery; (C) cystic artery origination from gastroduodenal artery; (D) cystic artery origination from aberrant right hepatic artery; (E) cystic artery origination from left hepatic artery; (F) cystic artery origination from liver parenchyma; (G)* 

The double cystic artery shows scenarios in which the superficial and deep branches of the CA have independent origins [14] (**Figure 1B**). Double cystic artery could be divided up based upon the position with regards to the bile ducts and portal vein and the hepatobiliary triangle [1, 4, 10]. Concerning the origins of double cystic arteries, they sometimes seem to be with the right hepatic artery or its partitions [1, 15]. According to Loukas et al., double cystic arteries originating both from Right hepatic artery and the posterior superior pancreaticoduodenal artery coexists having an accessory left hepatic artery originating from the left gastric

Ding et al.; defined a terminology called "compound cystic artery," in which the cystic arteries endured not just in the hepatobiliary triangle, but additionally outside of it [4]. Congenital absence of the deep branch of CA indicates the presence of an additional CA, and that is often recognized by subsequent hemostasis following LC. The posterior CA is extremely fragile in some instances, and it is frequently cut by electrocoagulation while in dissection. According to one study, such types of likelihood of vessel occurrence in 73 patients (12.2%); i.e. (double cystic artery) right after LC [4]. Suzuki et al. revealed incidence of double cystic artery in 27 cases (11.1%) out from 244 Japanese patients who undergone LC [1]. Zubair et al. noted the most typical variant with double CA in the Pakistani patients during the LC procedure. He witnessed the CA passing over the Calot's triangle, which had been observed in 26 (11.8%) scenarios out of 220 [17]. While in another research double cystic artery was present in only 3 of 300 cases (1%) [9]. In Western communities of Slovenians and Croatians, double cystic artery was documented in 13.6 and 5.5% of cases, correspondingly [10, 15]. In the recent research conducted by Yang et al., all patients experienced LC following the CT examinations [5]. The relationship between CA as well as the Calot's triangle was compared by the interventional radiologist and surgeon. Double cystic arteries were witnessed in 20 (27%) patients [5].

*DOI: http://dx.doi.org/10.5772/intechopen.81200*

cautious dissection [10].

*cystic artery syndrome.*

**Figure 1.**

**2.2 Double cystic artery**

artery [16].

*Cystic Artery Variations and Associated Vascular Complications in Laparoscopic Cholecystectomy DOI: http://dx.doi.org/10.5772/intechopen.81200*

#### **Figure 1.**

*Digestive System - Recent Advances*

attained significance [3].

**2.1 Single cystic artery**

**2. Types of cystic artery and its variation**

components of the gallbladder, correspondingly. Variants at the originations and course of CA are extremely typical. Uncontrolled arterial bleeding during LC is often a significant issue and might increase the likelihood of biliary duct injury. Consequently, appropriate recognition of the anatomy of the CA is essential. Cystic artery is excessively acknowledged to possess a highly diverse branching pattern. Therefore, given that LC had become the defacto standard to treat cholelithiasis, comprehension of anatomical vascular variations in hepatobiliary surgery has

The cystic artery commences within the Calot's triangle and most often starting from the right hepatic artery. When getting close to the gallbladder, it bifurcates into deep and superficial branches to the gallbladder neck. The exterior branch proceeds eventually left facet of the gallbladder. The deep branch goes throughout the connective tissues between gallbladder and liver parenchyma. The deep branch engenders really small offshoots to furnish the gallbladder, which anastomoses with all the superficial branches [4]. During open cholecystectomy, such type of CA is laterally located through the cystic duct within Calot's triangle. However in LC procedure, it is merely at the back and a bit much deeper contrary to cystic duct [4]. In a study, such type of variations were documented (73.3%) in 440 of 600 patients [4]. The intricate anatomical deviation among cystic arteries might increase the likelihood of injury throughout LC procedure [5]. Yet in another research, CT images had been analyzed prior to LC, were compared with intra-operative findings and postoperative results. It was witnessed that, cystic artery originating from the right hepatic artery were (76%) in most of the cases, while 55 (60%), CA originating from the right hepatic artery and it undergoes the Calot's triangle and reached the neck of the gallbladder in total of the 91 cases [5]. A single artery to cystic duct together with the conventional configuration of "H shaped" was revealed in 161 (91.47%) patients [6]. Within a current overview of 9800 patients, It is documented that the typical origination of cystic artery were from the RHA (79.02%), where as in 5427 patients (81.5%), origination was found in the hepatobiliary triangle [7]. Variations within cystic artery possessing clinical significance, located anterior to the common hepatic duct in 485 of 2704 patients (17.9%); whereas in 228 (5.4%), out of 4202 patients, located anterior to CBD, correspondingly [7]. A single CA was witnessed in 340 cases out of 740 patients. [8]. Single CA is present in 85% of sufferers out of 300 cases of LC [9]. On standard cholecystectomy, single CA sometimes appears within the hepatobiliary triangle and much more laterally positioned with the cystic duct, although while in laparoscopic view, it could be observed behind and marginally deeper compared to cystic duct [10]. In a recent study by Yang et al., the original source and variety of cystic arteries as well as their relationship together with the Calot's triangle was assessed by CT images and further it was compared with laparoscopic cholecystectomy results. They witnessed single CA was in 53 (73%) of the 73 patients [5]. In one study, normal origin of CA originating from the right hepatic artery was noticed in 72% of patients [11]. In accordance to the reported results, the conventional position of the cystic artery can be found in 70–80% of scenarios [4, 10–12] (**Figure 1A**). Within the study with Kenyan's populations, it had been stated that the CA stood a typical origin from the right hepatic artery in 92.2% of cases, although only one CA supplied the gallbladder within a comparable ratio [13]. With the laparoscopic point of view, a single or a

**124**

*Schematic illustrations of various anatomic anomalies of cystic artery during LC. (A) Cystic artery origination from right hepatic artery; (B) double cystic artery origination from right hepatic artery; (C) cystic artery origination from gastroduodenal artery; (D) cystic artery origination from aberrant right hepatic artery; (E) cystic artery origination from left hepatic artery; (F) cystic artery origination from liver parenchyma; (G) cystic artery syndrome.*

bit larger CA in length necessitates gentle exploration, as it can really be an aberrant hepatic artery, which needs to be dissociated from the cystic duct or gallbladder by cautious dissection [10].

#### **2.2 Double cystic artery**

The double cystic artery shows scenarios in which the superficial and deep branches of the CA have independent origins [14] (**Figure 1B**). Double cystic artery could be divided up based upon the position with regards to the bile ducts and portal vein and the hepatobiliary triangle [1, 4, 10]. Concerning the origins of double cystic arteries, they sometimes seem to be with the right hepatic artery or its partitions [1, 15]. According to Loukas et al., double cystic arteries originating both from Right hepatic artery and the posterior superior pancreaticoduodenal artery coexists having an accessory left hepatic artery originating from the left gastric artery [16].

Ding et al.; defined a terminology called "compound cystic artery," in which the cystic arteries endured not just in the hepatobiliary triangle, but additionally outside of it [4]. Congenital absence of the deep branch of CA indicates the presence of an additional CA, and that is often recognized by subsequent hemostasis following LC. The posterior CA is extremely fragile in some instances, and it is frequently cut by electrocoagulation while in dissection. According to one study, such types of likelihood of vessel occurrence in 73 patients (12.2%); i.e. (double cystic artery) right after LC [4]. Suzuki et al. revealed incidence of double cystic artery in 27 cases (11.1%) out from 244 Japanese patients who undergone LC [1]. Zubair et al. noted the most typical variant with double CA in the Pakistani patients during the LC procedure. He witnessed the CA passing over the Calot's triangle, which had been observed in 26 (11.8%) scenarios out of 220 [17]. While in another research double cystic artery was present in only 3 of 300 cases (1%) [9]. In Western communities of Slovenians and Croatians, double cystic artery was documented in 13.6 and 5.5% of cases, correspondingly [10, 15]. In the recent research conducted by Yang et al., all patients experienced LC following the CT examinations [5]. The relationship between CA as well as the Calot's triangle was compared by the interventional radiologist and surgeon. Double cystic arteries were witnessed in 20 (27%) patients [5].

### **2.3 Cystic artery origination from gastroduodenal artery (GDA)**

On few occasions, the CA emanate from the gastroduodenal artery or its branches, it is termed as "a low-lying cystic artery." Its terminal segment getting close to the gallbladder is essential for laparoscopic visual image [10]. On standing point of laparoscopic view, it is actually identified much more superficially or anteriorly to the cystic duct. Therefore, to be the first structure stumbled upon on cholecystectomy. In this instance, there is a probability of its intersection on dissecting the peritoneal replication hooking up the hepatoduodenal ligament to Hartman's pouch with the gall bladder or even the cystic duct. This anatomic deviation was discovered in 9 (4.5%) individuals [10]. The incidence with this anatomic discrepancy varies from 1 to 30% [2, 10, 18].(**Figure 1C**). In a latest review, based on clinically important anatomical variations of the cystic artery, it was witnessed that the aberrant gastroduodenal origination of cystic artery was (1.94%) out of 6898 cases [7]. Ding et al., founded such anatomic variation in 45 patients (7.5%) out from 600 sufferers addressed with LC [4]. As a whole of these terminal branches of artery, the way it approaches the gallbladder is essential for laparoscopic surgeons [4]. Given that, it should not merely be altered at an initial course. However, it is also vulnerable to injuries and hemorrhage throughout the dissection, especially while dealing with peritoneal folds at the joining point of hepatoduodenal ligament to Hartman's pouch on the gallbladder or the cystic duct [4].

#### **2.4 Aberrant right hepatic artery (RHA)**

The right hepatic artery (RHA) typically yields several tiny divisions providing gallbladder in contrast to a solitary cystic artery (**Figure 1D**). When masked by the gallbladder in the gallbladder fossa, it is prone to get the injury by cautery directly or by thermal injuries [10]. With the laparoscopic standpoint, a single large cystic artery necessitates gentle exploration, as it might be an aberrant hepatic artery, which needs to be dissociated with the cystic duct or gallbladder which additionally needs meticulous exploration [10]. The biliary anatomy of the Calot's triangle and extrahepatic vascular supply is widely known to become unpredictable and extremely diverse [19]. This allows a persistent obstacle to the surgeon carrying out LC. Cautious dissection of the cystic duct and artery is needed having consistent thoughts within the several anatomical chances to stay clear of either conversion necessitating postoperative bleeding or biliary leak. A replaced RHA is observed in 15–25% of patients, that the great majority disclose the RHA branching from the superior mesenteric artery [20, 21]. Inadvertent RHA ligation in cholecystectomy has become linked to liver ischemia, occasionally warranting resection of affected lobes of liver [22]. An aberrant RHA adherent to the cystic duct and gallbladder neck is referred to one of the most uncommon defects [19, 23]. Anatomical variants are frequent; in 6–16%, the right hepatic artery flows intently parallel to the cystic duct and could be mistakenly ligated during the LC, the structures within the triangle of Calot's are usually not evidently recognized [24]. Andall et al.; noted aberrant RHA origination of (5.58%), 385 out from 6898 cases. An aberrant RHA originating from the celiac trunk is an extremely unusual anatomical variant. Nevertheless, it might be connected with an irregular path of the cystic artery. Specialists have to know anatomical variations of the extrahepatic biliary tree and arterial supply in order to avoid feasible injuries throughout LC [25]. According to recent publicized research, focusing on the patients with combined bile duct and hepatic artery injuries during LC revealed, formation of liver abscesses in three of four cases and stricture's anastomotic site by 50% of four sufferers; on the other hand, these complications just weren't recognized in cases with separated biliary duct injuries [26].

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*Cystic Artery Variations and Associated Vascular Complications in Laparoscopic Cholecystectomy*

The earlier LC studies demonstrated an anomaly of right hepatic artery and were being disrupted during excessive hemorrhage throughout Calot's triangle dissection [27]. The outline with the surgery described the explanation for blood loss and also the intra-operative management with unspecified amounts of clips [27]. Ding et al., witnessed aberrant RHA in 18 (3%) of cases in their study [4]. The complicated structure of hepatic artery tends to make the hilar and perihilar area much more hazardous and vulnerable to a variety of traumas. The potential for biliary injuries might be of interest in patients who endure complicated or extended dissection with the Calot's triangle, accompanied by the roll-out of discomfort, fever and altered

The cystic artery in some instances emanates from the left hepatic artery, heading for the tunnel or through the liver and attaining the center of the gallbladder body or within the gall bladder fossa where it bifurcates it into two branches, which are namely called ascending and descending branches [10] (**Figure 1E**). This CA variance is simply not observed on endoscopic visualization with the hepatobiliary triangle, consequently necessitating extreme caution when treatment of gall bladder with the fossa [10]. Within one study, this sort of CA variation with typical caliber was discovered in 2 (1%) patients [10]. In accordance with the literature, it possesses an occurrence of 4%, where it was acknowledged and clipped [29]. The findings of CA origin were being with the left hepatic artery (2.07%), 143 out from 6898 cases. An aberrant RHA originating from the celiac trunk is an extremely uncommon anatomical variant. Nevertheless, it could be connected with an irregular path of the CA. Specialists should always keep in mind about the extrahepatic biliary tree and arterial supply anatomical variations to counteract attainable injuries while performing LC [25].

As outlined by Ding et al. [4]; This CA pierces the hepatic parenchyma getting close to the gallbladder base (**Figure 1F**). It usually situates inside the right lateral to the edge of gallbladder body and bottom part. Even so, a few are found in the middle of the gallbladder bed or located left lateral of gallbladder base. Hardly any other arterial blood vessels are located inside Calot's triangle [4]. This anatomic variation with the cystic artery is just not witnessed right until hemorrhaging and is because of dissection of the gallbladder fundus. It is sometimes complicated to understand more about and needs cautious dissection. It was witnessed in 15

Suzuki et al.; referred to a condition known as "cystic artery syndrome", in which the CA originates from the right hepatic artery, but uncommonly has a course that wraps across the cystic duct [1] (**Figure 1G**). They suggested that this course could result in reduced blood flow in the cystic duct, which exhibits clinically within the patient as cholelithiasis [1]. According to Zubair et al., this syndrome was discovered within 2% of the patients who underwent LC procedure [17].

Andall et al. lately have summarized the experiences of 55 experts, they analyzed 9800 cases and discovered only 20 instances where the CA arise straight

*DOI: http://dx.doi.org/10.5772/intechopen.81200*

liver function assessments [28].

**2.5 Aberrant left hepatic artery**

**2.6 Cystic artery origination from liver parenchyma**

patients (2.5%) within one another study [4].

**2.8 Abnormal origination of cystic artery**

**2.7 Cystic artery syndrome**

*Cystic Artery Variations and Associated Vascular Complications in Laparoscopic Cholecystectomy DOI: http://dx.doi.org/10.5772/intechopen.81200*

The earlier LC studies demonstrated an anomaly of right hepatic artery and were being disrupted during excessive hemorrhage throughout Calot's triangle dissection [27]. The outline with the surgery described the explanation for blood loss and also the intra-operative management with unspecified amounts of clips [27]. Ding et al., witnessed aberrant RHA in 18 (3%) of cases in their study [4]. The complicated structure of hepatic artery tends to make the hilar and perihilar area much more hazardous and vulnerable to a variety of traumas. The potential for biliary injuries might be of interest in patients who endure complicated or extended dissection with the Calot's triangle, accompanied by the roll-out of discomfort, fever and altered liver function assessments [28].

#### **2.5 Aberrant left hepatic artery**

*Digestive System - Recent Advances*

**2.3 Cystic artery origination from gastroduodenal artery (GDA)**

pouch on the gallbladder or the cystic duct [4].

**2.4 Aberrant right hepatic artery (RHA)**

On few occasions, the CA emanate from the gastroduodenal artery or its branches, it is termed as "a low-lying cystic artery." Its terminal segment getting close to the gallbladder is essential for laparoscopic visual image [10]. On standing point of laparoscopic view, it is actually identified much more superficially or anteriorly to the cystic duct. Therefore, to be the first structure stumbled upon on cholecystectomy. In this instance, there is a probability of its intersection on dissecting the peritoneal replication hooking up the hepatoduodenal ligament to Hartman's pouch with the gall bladder or even the cystic duct. This anatomic deviation was discovered in 9 (4.5%) individuals [10]. The incidence with this anatomic discrepancy varies from 1 to 30% [2, 10, 18].(**Figure 1C**). In a latest review, based on clinically important anatomical variations of the cystic artery, it was witnessed that the aberrant gastroduodenal origination of cystic artery was (1.94%) out of 6898 cases [7]. Ding et al., founded such anatomic variation in 45 patients (7.5%) out from 600 sufferers addressed with LC [4]. As a whole of these terminal branches of artery, the way it approaches the gallbladder is essential for laparoscopic surgeons [4]. Given that, it should not merely be altered at an initial course. However, it is also vulnerable to injuries and hemorrhage throughout the dissection, especially while dealing with peritoneal folds at the joining point of hepatoduodenal ligament to Hartman's

The right hepatic artery (RHA) typically yields several tiny divisions providing gallbladder in contrast to a solitary cystic artery (**Figure 1D**). When masked by the gallbladder in the gallbladder fossa, it is prone to get the injury by cautery directly or by thermal injuries [10]. With the laparoscopic standpoint, a single large cystic artery necessitates gentle exploration, as it might be an aberrant hepatic artery, which needs to be dissociated with the cystic duct or gallbladder which additionally needs meticulous exploration [10]. The biliary anatomy of the Calot's triangle and extrahepatic vascular supply is widely known to become unpredictable and extremely diverse [19]. This allows a persistent obstacle to the surgeon carrying out LC. Cautious dissection of the cystic duct and artery is needed having consistent thoughts within the several anatomical chances to stay clear of either conversion necessitating postoperative bleeding or biliary leak. A replaced RHA is observed in 15–25% of patients, that the great majority disclose the RHA branching from the superior mesenteric artery [20, 21]. Inadvertent RHA ligation in cholecystectomy has become linked to liver ischemia, occasionally warranting resection of affected lobes of liver [22]. An aberrant RHA adherent to the cystic duct and gallbladder neck is referred to one of the most uncommon defects [19, 23]. Anatomical variants are frequent; in 6–16%, the right hepatic artery flows intently parallel to the cystic duct and could be mistakenly ligated during the LC, the structures within the triangle of Calot's are usually not evidently recognized [24]. Andall et al.; noted aberrant RHA origination of (5.58%), 385 out from 6898 cases. An aberrant RHA originating from the celiac trunk is an extremely unusual anatomical variant. Nevertheless, it might be connected with an irregular path of the cystic artery. Specialists have to know anatomical variations of the extrahepatic biliary tree and arterial supply in order to avoid feasible injuries throughout LC [25]. According to recent publicized research, focusing on the patients with combined bile duct and hepatic artery injuries during LC revealed, formation of liver abscesses in three of four cases and stricture's anastomotic site by 50% of four sufferers; on the other hand, these complications just weren't recognized in cases with separated biliary duct injuries [26].

**126**

The cystic artery in some instances emanates from the left hepatic artery, heading for the tunnel or through the liver and attaining the center of the gallbladder body or within the gall bladder fossa where it bifurcates it into two branches, which are namely called ascending and descending branches [10] (**Figure 1E**). This CA variance is simply not observed on endoscopic visualization with the hepatobiliary triangle, consequently necessitating extreme caution when treatment of gall bladder with the fossa [10]. Within one study, this sort of CA variation with typical caliber was discovered in 2 (1%) patients [10]. In accordance with the literature, it possesses an occurrence of 4%, where it was acknowledged and clipped [29]. The findings of CA origin were being with the left hepatic artery (2.07%), 143 out from 6898 cases. An aberrant RHA originating from the celiac trunk is an extremely uncommon anatomical variant. Nevertheless, it could be connected with an irregular path of the CA. Specialists should always keep in mind about the extrahepatic biliary tree and arterial supply anatomical variations to counteract attainable injuries while performing LC [25].

#### **2.6 Cystic artery origination from liver parenchyma**

As outlined by Ding et al. [4]; This CA pierces the hepatic parenchyma getting close to the gallbladder base (**Figure 1F**). It usually situates inside the right lateral to the edge of gallbladder body and bottom part. Even so, a few are found in the middle of the gallbladder bed or located left lateral of gallbladder base. Hardly any other arterial blood vessels are located inside Calot's triangle [4]. This anatomic variation with the cystic artery is just not witnessed right until hemorrhaging and is because of dissection of the gallbladder fundus. It is sometimes complicated to understand more about and needs cautious dissection. It was witnessed in 15 patients (2.5%) within one another study [4].

#### **2.7 Cystic artery syndrome**

Suzuki et al.; referred to a condition known as "cystic artery syndrome", in which the CA originates from the right hepatic artery, but uncommonly has a course that wraps across the cystic duct [1] (**Figure 1G**). They suggested that this course could result in reduced blood flow in the cystic duct, which exhibits clinically within the patient as cholelithiasis [1]. According to Zubair et al., this syndrome was discovered within 2% of the patients who underwent LC procedure [17].

#### **2.8 Abnormal origination of cystic artery**

Andall et al. lately have summarized the experiences of 55 experts, they analyzed 9800 cases and discovered only 20 instances where the CA arise straight

from the superior mesentric artery (SMA) [7]. An uncommon scenario has been documented possessing CA arising from the SMA with abnormal branching in the CT and MRI within a Japanese woman cadaver [30]. The CA typically come across the ventral facet with the portal vein as well as the posterior side of the common bile duct. Additionally, in their case the CA have origination with the SMA and RHA and they leaped concurrent to Calot's triangle [30]. Consequently, in such instances, it is sometimes complicated for medical professionals to evaluate the origination of CA on account of the SMA [30]. The absence of congenital cystic artery was documented in 33 of 9836 (0.34%) cases [7]. While in another study, scholars mentioned the advantages of computed tomography angiography (CTA), and estimated that, it is quicker, much less intrusive and is through with considerably fewer irradiation exposure. CTA offers an appropriate and efficient depiction of cystic artery vessels in 924% of cases (95% CI, 87–98%) [7]. Nonetheless, variations, for instance, small or short CA, origins from aberrant hepatic artery or from an additional vessel completely results in the CA not passing throughout the cystohepatic triangle [7].
