Unique collateralisation between the left internal thoracic artery and the coeliac artery

Area of Science:

• Vascular anatomy and physiology
• Surgical anatomy
• Medical imaging

Background:

• Arterial collateralization is a critical compensatory mechanism for maintaining blood flow during stenosis or occlusion.
• Established collateral pathways, such as Winslow's pathway and the arc of Riolan, are well-documented.
• Understanding novel collateral pathways is essential for surgical planning and patient safety.

Observation:

• A unique collateral pathway was identified in a 76-year-old male patient with an abdominal aortic aneurysm.
• Computed tomography angiography revealed the collateral pathway connecting the left internal thoracic artery (LITA) to the coeliac artery.
• This pathway utilized the left inferior phrenic artery as an intermediary vessel.

Findings:

• The identified collateral pathway provides an alternative route for blood supply to the abdominal viscera.
• It demonstrates a previously uncharacterized connection between the thoracic and abdominal arterial systems.
• The pathway originates from the LITA and extends inferiorly to the coeliac artery.

Implications:

• Harvesting the LITA during coronary artery bypass grafting (CABG) may compromise blood flow to the abdominal organs.
• This finding has significant implications for cardiac surgeons, particularly when planning LITA utilization.
• Potential for acute mesenteric ischemia necessitates careful preoperative assessment and surgical consideration.