Illustrated Encyclopedia of Human Anatomic Variation: Opus IV: Organ Systems

Hepatic Pedicle

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed

1. The larger of 2 cystic arteries originates from the right ramus of the hepatic artery proper after the latter has passed behind the hepatic duct.
2. The cystic artery in this specimen is a branch of the right ramus of the hepatic artery proper, which crosses in front of the hepatic duct.
3. When the regular hepatic artery is absent, the artery to the left lobe of the liver arises as a branch of the celiac axis. The artery to the right lobe, derived from the superior mesenteric artery, passes obliquely upward and to the right, first posterior to the common bile duct, then to the right of it. Just before entering the right lobe of the lever, it gives origin to a large cystic branch to the hepatic surface of the gallbladder. The artery to the left lobe, derived from the celiac, contributes no cystic branch.
4. The cystic artery, originating from the left ramus of the proper hepatic artery, courses to the right in front of the hepatic duct.
5. An unusually long cystic artery derived from the proximal portion of the hepatic artery. The artery ascends to the right, then passes behind to common bile duct and portal vein.
6. The hepatic artery divides at a point distant from the porta; consequently the rami are exceptionally long. From the right ramus a cystic artery ascends to the gallbladder, and a gastroduodenal descends. From the left ramus, 3 arteries ascend to the left lobe of the liver, and a right gastric descends. Because of these arrangements the blood supply of the stomach is a constituent of the hepatic pedicle.
7. One of a pair of cystic arteries arises low as a branch of the gastroduodenal; it courses upward, then crosses in front of the common bile duct and the portal vein. The second cystic artery is a branch of the left ramus; it turns abruptly to the right and crosses in front of the left hepatic duct, then supplies the left half of the gallbladder and fossa.
8. A rare example of dual cystic arteries, fused distally (at arrow) to form a single terminal trunk, thus contributing to an arterial circle around the hepatic duct.
9. The cystic artery is derived, in the familiar way, from the right ramus of the proper hepatic artery. A large accessory hepatic duct from the right lobe of the liver enters the common bile duct just distal to the fusing point of the cystic and hepatic ducts.
10. The cystic duct enters the right hepatic duct. The cystic artery arises from the division point of the proper hepatic artery; it crosses in front of the right and left hepatic ducts to reach the gallbladder.

From Anson, 1956.

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