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| internal thoracic artery | |
|---|---|
| Name | Internal thoracic artery |
| Latin | arteria thoracica interna |
| Caption | Course of the internal thoracic artery |
| Branchfrom | subclavian artery |
| Branches | anterior intercostal arteries; perforating branches; musculophrenic artery; superior epigastric artery |
| Supplies | anterior chest wall; breasts; diaphragm (via musculophrenic) |
internal thoracic artery
The internal thoracic artery is a paired artery arising from the subclavian artery coursing caudally along the inner surface of the anterior thoracic wall. It contributes to the vascularization of the sternum, anterior intercostal spaces, breasts, and diaphragm and is notable for its role in coronary artery bypass grafting and in reconstructive surgery. Historically and clinically it intersects with developments in thoracic surgery and cardiovascular medicine pioneered in institutions such as Mayo Clinic, Cleveland Clinic, Johns Hopkins Hospital, Guy's Hospital, and Royal Brompton Hospital.
The internal thoracic artery originates from the inferior aspect of the first part of the subclavian artery near landmarks used in thoracic procedures; it descends posterior to the costal cartilages adjacent to the lateral border of the sternum and anterior to the transversus thoracis muscle. Along its course it gives off anterior intercostal branches that anastomose with posterior intercostal arteries from the thoracic aorta and perforating branches that supply the superficial tissues including the mammary gland and the overlying skin; at the sixth intercostal space it bifurcates into the musculophrenic artery and the superior epigastric artery, which continues toward the abdominal wall and anastomoses with branches of the external iliac artery via the inferior epigastric artery. Surrounding anatomical structures of surgical importance include the pleura, the costal margin, the thymus in pediatrics, and mediastinal nodes encountered during procedures performed at centers like Massachusetts General Hospital and Karolinska University Hospital.
Embryologically the internal thoracic artery arises from the developing ventral branches of the segmental arteries supplied by the embryonic dorsal aorta and evolves contemporaneously with the formation of the pleuropericardial folds and the mediastinum; its terminal branches reflect the morphogenesis of the anterior body wall and the diaphragm, which is associated with the septum transversum and pleuroperitoneal membranes implicated in congenital diaphragmatic defects documented in pediatric surgery literature from Great Ormond Street Hospital and Children's Hospital of Philadelphia. Developmental variants are informed by vascular remodeling processes described in embryology texts used at Harvard Medical School and Stanford University School of Medicine.
The internal thoracic artery supplies anterior thoracic structures including the sternum, anterior intercostal spaces, and the breast; its robust caliber, typically free of atherosclerotic disease relative to proximal coronary vessels, makes it a preferred conduit for coronary revascularization in ischemic heart disease treated at institutions such as Cleveland Clinic and Brigham and Women's Hospital. Clinically important anastomoses with the posterior intercostal arteries influence collateral circulation in cases of thoracic aortic occlusion managed by vascular teams at St Bartholomew's Hospital and Royal Infirmary of Edinburgh. Injury to the internal thoracic artery can lead to hemothorax or mediastinal hematoma encountered in trauma care at Royal London Hospital and in iatrogenic complications during central venous catheterization taught in curricula at University College London.
Anatomical variations include differences in origin from the first part of the subclavian artery or, less commonly, from the thyrocervical trunk or the costocervical trunk as described in comparative studies at Charité – Universitätsmedizin Berlin and University of Toronto. Variations in bifurcation level, branching pattern of anterior intercostal arteries, and presence of accessory branches supplying the breast are documented in anatomical atlases used at Columbia University Irving Medical Center and UCSF Medical Center. Knowledge of these variants is critical in planning procedures at specialty centers such as Memorial Sloan Kettering Cancer Center for oncologic resections and reconstruction.
The left internal thoracic artery is widely used as an arterial conduit for coronary artery bypass grafting (CABG), particularly to the left anterior descending artery, with long-term patency data reported in trials conducted at Cleveland Clinic, Stanford Health Care, and Mount Sinai Hospital. Pedicled and skeletonized harvesting techniques developed and refined at University of Pennsylvania and Royal Papworth Hospital influence sternal perfusion and wound complication rates; bilateral internal thoracic artery grafting has been evaluated in randomized trials at Cleveland Clinic and Papworth Hospital with attention to risks in diabetic and obese patients treated at Imperial College Healthcare NHS Trust. The artery is also employed in microsurgical breast reconstruction and chest wall reconstruction by plastic surgery units at Memorial Sloan Kettering Cancer Center and Royal Marsden Hospital.
Imaging modalities for the internal thoracic artery include computed tomography angiography (CTA) and magnetic resonance angiography (MRA) routinely used at Mayo Clinic and Johns Hopkins Hospital to evaluate patency after CABG, detect aneurysm or pseudoaneurysm, and plan reconstructive procedures. Conventional digital subtraction angiography performed in interventional suites at Mount Sinai Hospital and UCLA Medical Center remains the gold standard for endovascular assessment and embolization of bleeding sources. Ultrasound Doppler, taught in vascular labs at Guy's and St Thomas' NHS Foundation Trust, provides bedside assessment of flow in select cases.
Category:Arteries of the thorax