Internal thoracic artery

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Artery: Internal thoracic artery
Gray522.png
Right internal thoracic artery and its branches. (Internal mammary artery labeled at upper right.)
Latin 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
Dorlands
/ Elsevier
    
a_61/12156309

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Overview

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 on each side of the body.

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 posterior to the internal intercostal muscles, but anterior 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.

Branches

After passing the sixth intercostal space, the internal thoracic artery splits into the following two terminal branches:

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.

Diagnostic Cardiac Catheterization of the Left Internal Mammary Artery

In order to engage the left internal mammary artery, a view with slight cranial, and slight left anterior oblique (LAO) angulation is used. a Judkin's Right 4 catheter (JR 4) catheter is used to engage the ostium of the subclavian artery. With the catheter near the anticipated origin of the subclavian artery, a counterclockwise motion of the catheter is needed to engage the ostium. Once the ostium is engaged, an exchange length 0.038 J tipped wire is then advance into the subclavian artery. A left internal mammary artery (LIMA) catheter is then exchanged to engage the origin of the left internal mammary artery. Again, this engagement is accomplished with counterclockwise motion of the catheter. An injection with the camera in this angulation is a suitable first view of the LIMA, with careful attention in this view paid to the ostium of the LIMA. the next view is often a left anterior oblique (LAO) view with 90 degrees of angulation (LAO 90). This allows for accurate assessment of the LIMA anastomosis to the left anterior descending artery.

Additional images

References

  1. Kitamura S, Kawachi K, Kawata T, Kobayashi S, Mizuguchi K, Kameda Y, Nishioka H, Hamada Y, Yoshida Y. [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. 1996 Mar;97(3):202-9. PMID 8649330.
  2. Arima M, Kanoh T, Suzuki T, Kuremoto K, Tanimoto K, Oigawa T, Matsuda S. Serial Angiographic Follow-up Beyond 10 Years After Coronary Artery Bypass Grafting. Circ J. 2005 Aug;69(8):896-902. PMID 16041156. Free Full Text.
  3. Cohen G, Tamariz MG, Sever JY, Liaghati N, Guru V, Christakis GT, Bhatnagar G, Cutrara C, Abouzahr L, Goldman BS, Fremes SE. The radial artery versus the saphenous vein graft in contemporary CABG: a case-matched study. Ann Thorac Surg. 2001 Jan;71(1):180-5; discussion 185-6. PMID 11216742.

External links

Figures of ITA grafts


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