Anatomical study of the arterial supply of the extra-hepatic biliary system

Anomalous extrahepatic arterial supply to the biliary system is frequently encountered by surgeons. This study aimed to identify the arterial anomalies of this region and their clinical implications. Twenty cadavers, 10 digital subtractions and a CT image were included in this research. Regarding the cadaveric cases, accessory left or right hepatic arteries were noted in 15% of the sample; a middle hepatic artery was noted in 10%; the cystic artery was either anterior or posterior to the cystic duct in 21 and 79%, respectively. Double cystic arteries were seen in 5%. Angiographic results demonstrated that in 22.2%, the left hepatic artery was replaced, and originated from the left gastric artery. In 11.1%, a replaced right hepatic artery originated from the superior mesenteric artery. In another 11.1% a replaced gastroduodenal artery arose from superior mesenteric artery. The cystic artery branched from the right hepatic artery in 88.8% of the angiographic images. However, it originated from the left hepatic artery in 11.1% of the images. The CT image demonstrated that a common hepatic artery abnormally originated from the aorta. In conclusion, there are wide arterial variations of the extra-hepatic biliary tree. These findings will help to minimize the likelihood of postoperative complications during hepatobiliary surgeries.