Internal thoracic artery
| Artery: Internal thoracic artery | |
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| Right internal thoracic artery and its branches. (Internal mammary artery labeled at upper right.) | |
| Latin | arteria thoracica interna, arteria mammaria interna |
| Gray's | subject #148 583 |
| Source | Subclavian artery |
| Branches | Pericardiophrenic Anterior intercostal branches Musculophrenic Superior epigastric Perforating branches |
| Vein | Internal thoracic vein |
| MeSH | Mammary+Arteries |
In human anatomy, the internal thoracic artery (ITA), previously known as the internal mammary artery (a name still common among surgeons), is an artery that supplies the anterior chest wall and the breasts. 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.
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[edit] Course
The internal thoracic artery arises from the subclavian artery near its origin.
It travels downward on the inside of the ribcage, approximately a centimeter from the sides of the sternum, and thus medial to the nipple.
It runs deep to the internal intercostal muscles, but superficial to the transverse thoracic muscles.
It continues downward until it divides into the musculophrenic artery and the superior epigastric artery around the sixth intercostal space.
[edit] 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 travelling 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
[edit] Revascularization with the ITA
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[1][2] and other arterial grafts[3] (e.g. radial artery, gastroepiploic artery) when grafted to the left anterior descending coronary artery, generally the most important vessel, clinically, to revascularize. Plastic surgeons may use either the left or right internal thoracic arteries for autologous free flap reconstruction of the breast after mastectomy. Usually a micro-vascular anastomosis is performed at the second intercostal space to the artery on which the free flap is based.
[edit] Additional images
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Posterior surface of sternum and costal cartilages, showing Transversus thoracis.
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Transverse section of thorax, showing relations of pulmonary artery.
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The axillary artery and its branches.
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The right brachial plexus with its short branches, viewed from in front.
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Diagram of the course and branches of a typical intercostal nerve.
[edit] References
- ^ Kitamura, S; Kawachi, K; Kawata, T; Kobayashi, S; Mizuguchi, K; Kameda, Y; Nishioka, H; Hamada, Y et al (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 : official journal of the Japanese Circulation Society 69 (8): 896–902. doi:10.1253/circj.69.896. PMID 16041156. http://www.jstage.jst.go.jp/article/circj/69/8/896/_pdf.
- ^ 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.
[edit] External links
- -502923206 at GPnotebook - Internal thoracic artery
[edit] 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
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