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This study maps intercostal artery (ICA) anatomy to enhance safety in thoracic procedures. Puncturing over 10 cm from the spinous process offers the lowest risk, while punctures over 7 cm incur moderate risk.

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Area of Science:

  • Anatomy
  • Radiology
  • Thoracic Surgery

Background:

  • Percutaneous thoracic interventions carry risks related to intercostal artery (ICA) injury.
  • Precise anatomical knowledge of ICAs is crucial for procedural safety.

Purpose of the Study:

  • To define the anatomical course of the intercostal artery (ICA) in relation to thoracic structures.
  • To identify zones of varying risk for needle puncture during thoracic interventions based on ICA location.

Main Methods:

  • Analysis of arterial phase computed tomography (CT) data from 250 patients.
  • Definition of low, moderate, and high-risk zones based on ICA proximity to ribs and intercostal space (ICS).

Main Results:

  • The lowest risk zone for supracostal needle puncture is an ICA abutting the upper rib in the subcostal groove.
  • A high-risk zone is defined by ICA in the lower half of the ICS; a moderate-risk zone is below the subcostal groove but in the upper half of the ICS.
  • Risk zones showed demographic variability, with lateral extension in older patients and with more cranial ribs. Punctures >7 cm lateral to the spinous process incurred moderate risk, and >10 cm incurred the lowest risk.

Conclusions:

  • Intercostal artery (ICA) anatomical variations impact thoracic intervention safety.
  • CT-based risk stratification can guide needle placement to minimize ICA injury during thoracic procedures.
  • Optimal needle entry points for thoracic interventions can be determined by considering patient age, rib level, and puncture site lateral distance from the spinous process.