Novel anatomical variations of the internal thoracic artery: implications for coronary artery bypass grafting surgery and autologous breast reconstruction.

Abstract

The unique structure and location of the internal thoracic artery make it an ideal conduit for coronary artery bypass grafting surgery and autologous breast reconstruction. Variants with different characteristics have the potential to impact surgical success. This report presents a female body donor with a novel bilateral variation of the internal thoracic artery. The vessel arose from third segment of the subclavian artery, distal to it coursing deep to the anterior scalene muscle, and then proceeded to course anterior to the first rib, instead of posteriorly. This variation could detract from the desirability of the internal thoracic artery as a graft. Tractioning the artery over the first rib may render it too stenotic for surgical utility. In an individual who has undergone autologous breast reconstruction, this variation may prohibit adequate length preservation for use in subsequent coronary artery bypass grafting. Also, in the setting of thoracic outlet syndrome, this arterial variation may cause unforeseen complications post-grafting.