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| Posterior intercostal arteries | |
|---|---|
| Name | Posterior intercostal arteries |
| Latin | arteriae intercostales posteriores |
| Branch from | descending thoracic aorta, right subcostal artery, or supreme intercostal artery |
| Supply | intercostal spaces, vertebrae, spinal cord, pleura, chest wall muscles |
Posterior intercostal arteries are paired arteries that supply the posterior aspects of the intercostal spaces of the thorax. They typically arise from the descending thoracic aorta and contribute to vascular networks that anastomose with anterior thoracic vessels, participating in collateral circulation relevant to surgeries such as coronary artery bypass grafting and procedures involving the thoracic aorta. These arteries are clinically relevant in contexts including traumatic rib fractures, procedures at the posterior mediastinum, and pathologies managed in institutions like Mayo Clinic and Johns Hopkins Hospital.
The posterior intercostal arteries are generally grouped as the first two posterior intercostal arteries arising from the supreme intercostal artery (a branch of the costocervical trunk of the subclavian artery), while the remaining nine pairs originate from the descending thoracic aorta along the posterior thoracic wall. Their segmental distribution mirrors the arrangement of the thoracic spinal nerves and the intercostal muscles, traveling within the costal groove of adjacent ribs beside the intercostal vein and the intercostal nerve. The positional relationships are important in interventions at the inferior vena cava level, during operations described in textbooks from publishers like Elsevier and Springer.
Each posterior intercostal artery gives off dorsal branches to the vertebral column, spinal meninges, and medulla supplied in part through segmental medullary arteries such as the clinical important artery of Adamkiewicz. Near the anterior aspect of the intercostal space, they anastomose with anterior intercostal branches of the internal thoracic artery (internal mammary), contributing to collateral pathways considered during angioplasty and bypass planning at centers such as Cleveland Clinic. The arteries run anterolaterally in the costal groove beneath the corresponding rib and communicate with musculophrenic branches and branches to the diaphragm, relevant in surgeries involving the phrenic nerve.
Posterior intercostal arteries lie superior to the corresponding intercostal veins and inferior to the intercostal nerves in the typical neurovascular bundle arrangement, a relationship emphasized in regional anesthesia texts from institutions like Stanford University and Harvard Medical School. They run deep to the Serratus posterior inferior muscle and superficial to the heads of the transversus thoracis muscle and pleural reflections near the parietal pleura. The proximity to the thoracic duct on the left and the azygos vein system on the right is significant for mediastinal surgery and imaging at centers including Massachusetts General Hospital.
Variability includes differing origins such as large posterior intercostal trunks from the descending thoracic aorta, contribution from the subcostal artery, or hypertrophy when anterior routes are occluded, observed in angiographic studies at Guy’s Hospital and research published by World Health Organization collaborating centers. The level and number of segmental medullary branches like the artery of Adamkiewicz vary between individuals and populations studied by groups at Karolinska Institutet and University College London, affecting risk stratification in thoracoabdominal aortic repair performed at specialist units like Cleveland Clinic and Mount Sinai Health System.
The posterior intercostal arteries supply the muscles and overlying skin of the posterior thoracic wall, the parietal pleura, and send spinal branches to the vertebral bodies and spinal cord, contributing to the segmental blood supply that supports neural elements targeted in procedures at Hopkins Hospital. Their anastomoses with the internal thoracic and musculophrenic arteries maintain perfusion during occlusive disease of the thoracic aorta and are therefore relevant to pathologies managed in vascular centers such as Royal Brompton Hospital.
Injury to posterior intercostal arteries can cause life-threatening hemothorax in trauma settings, a complication managed in trauma centers like Royal London Hospital and St Thomas’ Hospital. During posterolateral thoracotomy or chest tube insertion, knowledge of the artery’s location beneath the rib is crucial to avoid hemorrhage, a teaching point in surgical curricula at University of Oxford and Yale School of Medicine. Embolization of intercostal arteries is sometimes performed for control of bleeding or tumor vascularity in interventional radiology units at Toronto General Hospital and Singapore General Hospital, with the artery of Adamkiewicz posing a risk factor for spinal ischemia during endovascular repairs at high-volume centers like John Radcliffe Hospital.
Segmental posterior intercostal arteries arise from the remodeling of dorsal aortic branches during embryogenesis, a process paralleling the segmentation of the paraxial mesoderm and development of the somites studied in developmental biology programs at Max Planck Institute and Salk Institute. Variations in the formation of segmental arteries relate to the lateral intersegmental arteries’ fate and have been described in embryologic atlases used at University of Cambridge and Columbia University for planning pediatric and congenital thoracic interventions.
Category:Arteries of the thorax