Internal thoracic artery

In human anatomy, the internal thoracic artery (ITA), previously commonly known as the internal mammary artery (a name still common among surgeons), 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.

Internal thoracic artery
Right internal thoracic artery and its branches (labeled under its old name the Internal mammary artery, at upper right.)
Details
SourceSubclavian artery
BranchesPericardiocophrenic
Anterior intercostal branches
Musculophrenic
Superior epigastric
Perforating branches
VeinInternal thoracic vein
Identifiers
LatinArteria thoracica interna, arteria mammaria interna
MeSHD008323
TA98A12.2.08.029
TA24576
FMA3960
Anatomical terminology

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.

In adults, internal thoracic artery lies closest to the sternum at the first intercoastal space. The gap between the artery and lateral border of the sternum increases when going downwards, up to 1.1cm to 1.3cm at sixth intercoastal space. In children, the gap range from 0.5cm to 1.0cm.[5]

Branches

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

  • Musculophrenic artery - roughly follows the costal margin and it again gives branch for 7,8,9 ribs
  • Superior epigastric artery - continues the course of the internal thoracic artery, travelling downward into the abdominal wall and to the content of recuts sheath

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[6][7] and other arterial grafts[8] (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
  1. 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
  2. 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
  3. 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
  4. 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
  5. Jelicić N, Djordjević L, Stosić T (1996). "Unutrasnji grudni krvni sudovi (a. et vv. thoracicae internae) i njihov prakticni znacaj" [The internal thoracic blood vessels (internal thoracic arteries and veins) and their practical significance]. Srpski Arhiv Za Celokupno Lekarstvo (in Serbian). 124 (3–4): 58–61. PMID 9102819.
  6. 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.
  7. 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.
  8. 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.
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Figures of ITA grafts
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