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. 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. The internal thoracic artery arises from the anterior surface of the subclavian artery near its origin. It has a width of between 1-2 mm. It travels downward on the inside of the rib cage, approximately 1 cm from the sides of the sternum, 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. The internal thoracic artery supplies the chest wall and the breasts. 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 and other arterial grafts (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 microvascular anastomosis is performed at the second intercostal space to the artery on which the free flap is based. The internal mammary artery (IMA) has been used in pioneering surgeries since the middle of last century, but it became the graft of choice only in the 1980s, after widespread angiographic and clinical demonstration of its superiority over the saphenous vein graft (SVG). The use of both mammary arteries was then explored in order to achieve better long-term results when compared to single IMA and SVG. The IMA can be harvested pedicled or skeletonized and used as an in situ graft or as a source for composite graft (Y- graft, lengthened graft). When the bilateral internal mammary artery (BIMA) is grafted in situ, the left internal mammary artery (LIMA) is generally used for the left descending artery (LAD) and the RIMA for the right coronary artery (RCA), or for the lateral wall, usually going through the transverse sinus. In the case of Y-graft, the left coronary system is more frequently chosen as the target site of revascularization.
Media Contact:
John Mathews
Journal Manager
Current Trends in Cardiology