Abstract
Introduction
Predictable intrathoracic course, anatomical proximity to heart and long-term patency has made Internal thoracic artery (ITA) a conduit of choice in coronary artery bypass grafting (CABG). Its frequent bilateral use has necessitated the need to have a comparative knowledge of surgical anatomy of ITA on both sides.
Methods
A random study was conducted on 100 adult human cadavers. Sternocostal wall was removed and fixed in 10% formalin and dissected for detailed anatomy of ITA. All observations were expressed as mean ± 2SD and appropriate statistical analysis conducted.
Observations
ITA originated in common trunk with other branches of subclavian artery in 12% on right side and 4% on left. Mean length of right ITA was 20.15 ± 1.22 cm, left 19.83 ± 1.66 cm in 28% of cases where bilateral ITA terminated in 6th Intercostal space (ICS). On pattern of origin of sternal branches from ITA 3 groups were observed. Group-I-some sternal branches arising from common trunk of ITA on both sides (24%), Group-II-some sternal branches arising from common branch of ITA on one side only (54%), Group-III-all sternal branches arising directly from ITA on both sides (22%). Phrenic nerve crossed anterior to ITA on both sides in 52%, posteriorly in 14% and in remaining it crossed anteriorly on one side and posteriorly on other.
Conclusion
Variations as described in our study in relations to phrenic nerve, level of bifurcation and sternal blood supply must be kept in mind while harvesting bilateral ITA to reduce risk of sternal dehiscence by preserving the sternal blood supply from common trunk and to prevent post operative phrenic nerve palsy.
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Puri, N., Gupta, P.K., Mahant, T.S. et al. Bilateral internal thoracic artery harvesting; anatomical variations to be considered. Indian J Thorac Cardiovasc Surg 23, 192–196 (2007). https://doi.org/10.1007/s12055-007-0036-3
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DOI: https://doi.org/10.1007/s12055-007-0036-3