The clinical anatomy of the internal thoracic veins

The branching pattern and adequacy of the internal thoracic veins (ITV) are important factors, providing useful information on the availability of vessels and their appropriateness as an option for anastomoses in plastic and reconstructive surgery. During 100 cadaveric examinations of the anterior thoracic wall it was observed that ITVs were formed by the venae commitantes of ITAs, which united to form a single vein (one for the right side and one for the left) draining into the right and left brachiocephalic veins. The tributaries of ITVs corresponded to the branches of ITA. The right internal thoracic vein bifurcated at the 2(nd) rib in 36% of the specimens, at the 3(rd) rib in 30% of the specimens, at the 4(th) rib in 10% of the specimens and in 24% of the specimens it remained a single vein. The left internal thoracic vein bifurcated at the 3(rd) rib in 52% of specimens, at the 4(th) rib in 20% of specimens and in 28% of the specimens it remained as a single vein. In addition, it was observed that in 78% of specimens ITVs were connected to each other by a venous arch. This arch displayed four distinct morphologies: transverse (n = 7), oblique (n = 16), U-shaped (n = 51) and double-arched (n = 4). All 78 arches were posterior to the xiphisternal joint and no artery accompanied them. In the remaining specimens, RITV and LITV exhibited a venous plexus formation. The distance from the sternum to ITV gradually decreased as the vessel passed caudally; the diameter of the vessel similarly decreased along the vein's caudal course. The frequent appearance of two concomitant veins on both sides of the thorax may offer the opportunity to reduce venous congestion by two vein anastomoses. More detailed knowledge of the anatomy of ITV may prove useful in planning surgical procedures in the anterior thorax in order to avoid unexpected bleeding.