The celiac axis demonstrates considerable anatomic variability, and awareness of these variations is essential for surgeons performing hepato-pancreato-biliary procedures. The posterior superior pancreaticoduodenal artery (PSPDA) typically arises from the gastroduodenal artery and forms collateral circulation with the posterior inferior pancreaticoduodenal artery (PIPDA) to supply the posterior pancreatic head, duodenum, and common bile duct. The cystic artery typically arises from the right hepatic artery to supply the gallbladder and cystic duct. Both arteries are involved in various abdominal surgeries; thus, describing variations of these vessels adds to the anatomical literature and may improve preoperative planning and intraoperative techniques. A formalin-fixed, 90-year-old male cadaver from the Colorado Anatomical Board’s Anatomical Gift Program was dissected by Pre-Doctoral Anatomy Fellows using Rocky Vista University’s dissection guide. Two variations were identified: 1) the PSPDA originated from the right hepatic artery, and 2) the cystic artery originated from the PSPDA. Further, the cystic artery exhibited an atypical trajectory, coursing anterior to the cystic duct and common bile duct, rather than posteriorly within the cystohepatic triangle. These variations have important implications in surgical procedures involving the pancreas, duodenum, and gallbladder. A variant origin of the PSPDA, along with an atypical cystic artery arising from it, poses a risk of complications during cholecystectomies, pancreaticoduodenectomies, Frey/Beger procedures, and more. Incorrect ligation or clamping may compromise perfusion to the gallbladder, pancreatic head, and duodenum. Documentation of these variations enhances understanding of regional vascular complexity and highlights the need for imaging to carefully identify arterial patterns before hepato-pancreato-biliary operations.
