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Internal thoracic artery-inferior epigastric artery as a collateral pathway in aortoiliac occlusive disease

Mehmet Yurdakul1, Muharrem Tola, Ensar Ozdemir

  • 1Department of Radiology, Türkiye Yüksek Ihtisas Hospital, Sihhiye Ankara, Turkey. myurdakul@tyih.gov.tr

Journal of Vascular Surgery
|April 18, 2006
PubMed

Insights

The internal thoracic artery-inferior epigastric artery (ITA-IEA) collateral pathway is crucial for lower-extremity perfusion in aortoiliac occlusion, supplying 38% of blood flow. Doppler sonography can assess this vital collateral route.

Area of Science:

  • Vascular Surgery
  • Diagnostic Imaging
  • Hemodynamics

Background:

  • Aortoiliac occlusion can lead to severe leg ischemia due to compromised blood flow.
  • The internal thoracic artery-inferior epigastric artery (ITA-IEA) functions as a critical collateral pathway to the lower extremities.
  • Interruption of the ITA-IEA collateral may exacerbate leg ischemia in patients with aortoiliac occlusive disease.

Purpose of the Study:

  • To evaluate the ITA-IEA collateral pathway using color duplex ultrasonography.
  • To determine the significance of the ITA-IEA collateral in providing lower-extremity perfusion in aortoiliac occlusive disease.

Main Methods:

  • Prospective color duplex ultrasonography scans in 64 patients with aortoiliac occlusion.
  • Measurement of blood flow in the ITA, IEA, and common femoral artery.
  • Stratification of patients based on occlusion level (aorta, common iliac, external iliac) for comparative analysis.

Main Results:

  • The ITA-IEA pathway was functional in 95% of patients, with a mean collateral flow of 66 mL/min.
  • This collateral contributed an average of 38% to lower-extremity perfusion.
  • Collateral flow and perfusion contribution decreased with more distal aortoiliac occlusion levels.

Conclusions:

  • The ITA-IEA collateral pathway is a significant contributor to lower-extremity perfusion in aortoiliac occlusion.
  • Doppler sonographic assessment of ITA-IEA collateral flow provides valuable pre-treatment information.
  • This assessment is particularly important for patients undergoing coronary artery bypass grafting using the ITA.
Abstract

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