Cystic Artery Arising at the Origin of the Middle Hepatic Artery: Anatomical Relationships and Surgical Implications

Purpose. The cystic artery most commonly arises from the right hepatic artery, but clinically important variations in origin and course are well documented. This study describes an uncommon cystic artery arising at the origin of the middle hepatic artery, emphasizing its relationship with the common hepatic duct and the continuation of the middle hepatic artery toward hepatic segment IV. Methods. The hepatobiliary region of an adult female formalin-preserved cadaver was carefully dissected to expose the extrahepatic biliary tract, gallbladder, cystic artery, and hepatic arterial branches. The anatomical arrangement was documented photographically from complementary viewpoints. Results. The cystic artery arose at the origin of the middle hepatic artery rather than from the right hepatic artery. It crossed anterior to the common hepatic duct before proceeding toward the gallbladder. The middle hepatic artery was positioned to the left of the common hepatic duct and continued toward hepatic segment IV, whereas the right hepatic artery passed posterior to the duct. Conclusion. This configuration is surgically relevant because a vessel destined for the gallbladder shares its origin with a hepatic arterial branch that continues toward segment IV. Recognition of the proximal origin and distal hepatic continuation of these vessels may reduce the risk of vascular misidentification, hemorrhage, inadvertent hepatic arterial ligation, and biliary injury during hepatobiliary procedures.