Internal thoracic artery
Internal thoracic artery | |
---|---|
Details | |
Source | Subclavian artery |
Branches | Pericardiocophrenic Anterior intercostal branches Musculophrenic Superior epigastric Perforating branches |
Vein | Internal thoracic vein |
Identifiers | |
Latin | Arteria thoracica interna, arteria mammaria interna |
MeSH | D008323 |
TA98 | A12.2.08.029 |
TA2 | 4576 |
FMA | 3960 |
Anatomical terminology |
In human anatomy, the internal thoracic artery (ITA), previously commonly known as the internal mammary artery (a name still common among surgeons[citation needed]), is an artery that supplies the anterior chest wall and the breasts.[1] It is a paired artery, with one running along each side of the sternum, to continue after its bifurcation as the superior epigastric and musculophrenic arteries.
Structure[]
The internal thoracic artery arises from the anterior surface of the subclavian artery near its origin.[2][3] It has a width of between 1-2 mm.[4]
It travels downward on the inside of the rib cage, approximately 1 cm from the sides of the sternum,[3] and thus medial to the nipple. It is accompanied by the internal thoracic vein.
It runs deep to the abdominal external oblique muscle, but superficial to the vagus nerve.
Branches[]
- Mediastinal branches
- Thymic branches
- Pericardiacophrenic artery - travels with the phrenic nerve
- Sternal branches
- Perforating branches
- Twelve anterior intercostal branches, two to each of the top six intercostal spaces. In a given space, the upper branch travels laterally along the bottom of the rib until it anastomoses with its corresponding posterior intercostal artery. The lower branch of the space anastomoses with a collateral branch of the posterior intercostal artery.
After passing the sixth intercostal space, the internal thoracic artery splits into the following two terminal branches:
- Musculophrenic artery - roughly follows the costal margin
- Superior epigastric artery - continues the course of the internal thoracic artery, travelling downward into the abdominal wall
Function[]
The internal thoracic artery supplies the chest wall and the breasts.[1]
Clinical significance[]
Use in bypass grafts[]
The internal thoracic artery is the cardiac surgeon's blood vessel of choice for coronary artery bypass grafting. The left ITA has a superior long-term patency to saphenous vein grafts[5][6] and other arterial grafts[7] (e.g. radial artery, gastroepiploic artery) when grafted to the left anterior descending coronary artery, generally the most important vessel, clinically, to revascularize.[1]
Plastic surgeons may use either the left or right internal thoracic arteries for autologous free flap reconstruction of the breast after mastectomy. Usually, a microvascular anastomosis is performed at the second intercostal space to the artery on which the free flap is based.
Additional images[]
Anterior Thoracic Wall, from behind
Diagram of an Intercostal Space
References[]
- ^ Jump up to: a b c Kramer, R. S.; Morton, J. R.; Groom, R. C.; Robaczewski, D. L. (2018-01-01), "Coronary Artery Bypass Grafting", in Vasan, Ramachandran S.; Sawyer, Douglas B. (eds.), Encyclopedia of Cardiovascular Research and Medicine, Oxford: Elsevier, pp. 700–729, doi:10.1016/b978-0-12-809657-4.99754-0, ISBN 978-0-12-805154-2, retrieved 2020-11-12
- ^ Stewart, Charles E.; Urken, Mark L. (2009-01-01), Wei, Fu-Chan; Mardini, Samir (eds.), "CHAPTER 18 - Deltopectoral flap", Flaps and Reconstructive Surgery, Edinburgh: W.B. Saunders, pp. 193–205, doi:10.1016/b978-0-7216-0519-7.00018-6, ISBN 978-0-7216-0519-7, retrieved 2020-11-12
- ^ Jump up to: a b Barral, Jean-Pierre; Croibier, Alain (2011-01-01), Barral, Jean-Pierre; Croibier, Alain (eds.), "13 - Vessels of the breast", Visceral Vascular Manipulations, Oxford: Churchill Livingstone, pp. 121–132, doi:10.1016/b978-0-7020-4351-2.00013-2, ISBN 978-0-7020-4351-2, retrieved 2020-11-12
- ^ Markiewicz, Michael R.; Ord, Robert; Fernandes, Rui P. (2017-01-01), Brennan, Peter A.; Schliephake, Henning; Ghali, G. E.; Cascarini, Luke (eds.), "43 - Local and Regional Flap Reconstruction of Maxillofacial Defects", Maxillofacial Surgery (Third Edition), Churchill Livingstone, pp. 616–635, doi:10.1016/b978-0-7020-6056-4.00044-7, ISBN 978-0-7020-6056-4, retrieved 2020-11-12
- ^ Kitamura, S; Kawachi, K; Kawata, T; Kobayashi, S; Mizuguchi, K; Kameda, Y; Nishioka, H; Hamada, Y; Yoshida, Y (1996). "Ten-year survival and cardiac event-free rates in Japanese patients with the left anterior descending artery revascularized with internal thoracic artery or saphenous vein graft: a comparative study". Nippon Geka Gakkai Zasshi. 97 (3): 202–9. PMID 8649330.
- ^ Arima, M; Kanoh, T; Suzuki, T; Kuremoto, K; Tanimoto, K; Oigawa, T; Matsuda, S (2005). "Serial angiographic follow-up beyond 10 years after coronary artery bypass grafting". Circulation Journal. 69 (8): 896–902. doi:10.1253/circj.69.896. PMID 16041156.
- ^ Cohen, G; Tamariz, MG; Sever, JY; Liaghati, N; Guru, V; Christakis, GT; Bhatnagar, G; Cutrara, C; et al. (2001). "The radial artery versus the saphenous vein graft in contemporary CABG: a case-matched study". The Annals of Thoracic Surgery. 71 (1): 180–5, discussion 185–6. doi:10.1016/S0003-4975(00)02285-2. PMID 11216742.
External links[]
Wikimedia Commons has media related to Internal thoracic artery. |
Figures of ITA grafts[]
- Figure of heart with two saphenous vein grafts (SVGs) and a LITA graft - texheartsurgeons.com
- Drawing of the heart with a SVG to the right coronary artery (RCA) and a LITA graft to the LAD - darcystudios.com
- Drawing of the heart with a SVG to the RCA and a LITA graft to the LAD - mayoclinic.org
- Arteries of the thorax