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The role of the internal thoracic artery in the sternal blood supply
F W Knudsen1, M Andersen, U Niebuhr
1Department of Plastic Surgery, University Hospital, Gentofte, Denmark.
Insights
Coronary bypass surgery using the internal thoracic artery significantly reduces sternal blood supply. This study reveals the internal thoracic artery is crucial for sternal vascularization, impacting healing after cardiac procedures.
Area of Science:
- Anatomy
- Vascular Surgery
- Cardiology
Background:
- The internal thoracic artery is commonly used in coronary artery bypass grafting.
- Understanding its impact on sternal blood supply is vital for patient recovery and preventing complications.
Purpose of the Study:
- To investigate the alterations in sternal arterial supply after harvesting the internal thoracic artery.
- To determine the dominant vascular sources supplying the sternum.
Main Methods:
- Delineation of the sternal arterial system using plastic material in 17 human cadaver chest walls.
- Injection of ink/barium contrast for radiographic and microscopic analysis.
- Assessment of arterial supply before and after internal thoracic artery harvest.
Main Results:
- The primary blood supply to the sternum is periosteal, originating almost exclusively from internal thoracic artery branches.
- Harvesting the internal thoracic artery compromises the sternal arterial supply, particularly to the upper corpus sterni.
- Sparse collateral supply to the periosteal membrane comes from the thoracoacromial artery via pectoralis major muscle branches.
Conclusions:
- The internal thoracic artery plays a dominant role in sternal vascularization.
- Sternal blood supply is significantly compromised after internal thoracic artery harvest, potentially affecting healing.
- Alternative vascularization pathways are limited, highlighting the importance of preserving sternal perfusion.
Abstract:
The altered arterial supply to the sternum after use of the internal thoracic artery in coronary bypass surgery was studied by delineation of the sternal arterial system with plastic material and by injection of ink/barium contrast for radiography and microscopy. The study was performed on 17 anterior chest walls from human cadavers. The total arterial supply was charted before and after 'harvest' of the internal thoracic artery. The dominant blood supply to the sternum was found to be periosteal and derived almost exclusively from branches of the internal thoracic artery. Following harvest of that artery, the arterial supply to the upper part of the corpus sterni was compromised, and based only on sparse ramifications to the periosteal membrane from the thoracoacromial artery via branches from the pectoralis major muscle.