Clinical anatomy of internal thoracic artery branches

Abstract

The broad clinical utilization of the internal thoracic artery (ITA), including the role of its branches in supplying circulation to the sternum, requires explicit anatomic knowledge of this vessel. Fifty‐six ITAs (28 right, 28 left) were dissected from their point of origins after injection with a mixture of contrast medium and latex after perfusion with saline and immersion in 4% formaldehyde. All ITA branches were studied according to their course, size, and distribution within intercostal spaces with the aid of an operating microscope. The branches were divided in two main groups: proper (solitary) branches and common trunks. The proper branches consisted of four types: sternal, perforating, intercostal, and mediastinal. The four types of common trunks were: sternal/perforating, sternal/intercostal, perforating/intercostal, sternal/perforating/intercostal. Points of most frequent origin from main trunk of the vessel were established for each type. Mean external diameter of proper branches was 0.72 mm and common trunks was 1.06 mm. Mean length of common trunks was 3.0 mm. Those parameters (adequate diameter and length) allow for ligation of the common trunks close to the ITA so that their points of division can be preserved. This fact is crucial for creation of collateral blood supply to the sternum after bilateral ITA mobilizations. Clin. Anat. 12:307–314, 1999. © 1999 Wiley‐Liss, Inc.

Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection

“…The bloodstream is, as indicated by Arnold, presumably fed by interceptions of the subcostal und thoraco-acromial arteries. Discharging branches from the common trunk reach to the mediastinum, the sternum or the intercostal muscle and potentially function as a conduit for the collateral blood circulation system of the sternum [19]. …”

Abnormal origin of internal thoracic artery from the thyrocervical trunk: surgical considerations

“…That accessory ITA may originate in an incidence of 4.54 % [21], 10.8 % [20] or 15 % [16]. The ITA’s parietal branches, thus the anterior intercostal, sternal, perforating and mediastinal arteries may arise separately or from a common trunk and the branching patterns have been classified into four types for the case of common trunk and four types for the separate branches [2]. The average artery length varies from 18.07 cm [18] to 20.4 cm [16].…”

“…It is widely utilized for coronary artery bypass grafting (CABG) surgery. The ITA’s anatomic characteristics, such as distinct intrathoracic course and anatomical vicinity with the heart [1], its long-term patency [1-4], the long-term survival rate [2,4] and post-operative quality of life [5] render it as an excellent arterial graft for myocardial revascularization.…”

The descending branch of the lateral circumflex femoral artery as an alternative conduit for coronary artery bypass grafting: Experience from an anatomical, radiological and histological study

“…The ITA is also not to be removed bilaterally from patients with expected difficulty in healing of the sternum, such as those suffering from diabetes, severe obesity, or osteoporosis (some of these contraindications may be relative). As shown by Pietrasik et al (1999), bilateral ITA mobilization is possible only in patients with adequate diameter and length of the ITA common trunks and branches.…”