Cystic Artery Arising Accessory Right Hepatic Artery

Surgical video case: cystic artery arising accessory right hepatic artery is a relatively uncommon anatomical variation that surgeons need to be keenly aware of during hepatobiliary and pancreatic surgery. The "accessory" right hepatic artery (ARHA) is a supplementary vessel suppling a portion of the liver, separate from the superior mesentric artery, common hepatic artery, right renal artery or even directly from aorta. When the cystic artery originates from this ARHA rather than its more typical origin from the right hepatic artery itself,  it presents a higher risk of inadvertent injury during cholecystectomy. The risk stems from the altered course and location of the cystic artery. It might be located deeper, have a more tortuous path, or be closer to the bile duct than anticipated, increasing the likelihood of clamping, ligating, or cauterizing it unintentionally.  Moreover, the ARHA itself can be inadvertently injured if mistaken for the cystic artery, resulting in significant hepatic ischemia.

During surgery, meticulous dissection and careful identification of the cystic artery and its origin are essential.  Utilizing techniques like the "critical view of safety" minimizes the risk of vascular injury.