Abnormal origin of internal thoracic artery from the thyrocervical trunk: surgical considerations

Paraskevas, George; Natsis, Konstantinos; Tzika, Maria; Ioannidis, Orestis; Kitsoulis, Panagiotis

doi:10.1186/1749-8090-7-63

Cited by 15 publications

(6 citation statements)

References 31 publications

(55 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has been suggested that a common origin of the ITA and TCT would complicate surgical grafting procedures, as the curved direction of the common trunk makes the implant vulnerable to kinking from traction in harvesting (10). Th is was not observed in our patient.…”

Section: Discussionmentioning

confidence: 54%

Abnormal Origin of the Left Internal Thoracic Artery Detected Only by Computed Tomography

McMaster¹,

Blanc²,

Hamman³

et al. 2013

Baylor University Medical Center Proceedings

View full text Add to dashboard Cite

The origins of the branches of the subclavian artery are known to be variable. We present the case of a 55-year-old man whose coronary artery bypass surgery necessitated the use of the internal thoracic artery as he lacked other suitable venous conduits. The left internal thoracic artery appeared to be absent on subselective subclavian angiography. Computed tomographic angiography revealed a previously undescribed anomaly: origin of the internal thoracic artery from a thyrocervical trunk arising directly from the aortic arch. CASE REPORTA 55-year-old steel company supervisor with multiple coronary risk factors had previously undergone multivessel coronary stenting following an abnormal stress test. One year later, a repeat stress test was again abnormal, and a new drug-eluting stent was placed in a de novo lesion. Dual antiplatelet therapy was continued. Several days later the patient reported a progressively severe headache, and computed tomography (CT) scanning revealed an acute right temporoparietal hemorrhagic infarct. All antiplatelets were discontinued. Seven months later, he developed angina pectoris, and repeat coronary angiography showed multiple stenoses necessitating coronary artery bypass grafting (CABG).During angiography, the operator was unable to visualize the left internal thoracic artery (ITA) even on subselective injections of the subclavian artery (SCA). As the patient had previously undergone bilateral lower-extremity vein stripping, knowledge of the presence and suitability of the ITA was deemed essential given the paucity of potential graft conduits. CT angiogram revealed the presence of the left ITA arising from the thyrocervical trunk (TCT), which arose directly from the aortic arch (Figure). Flow in the ITA was not impeded.During the operation the left ITA was successfully harvested and had visibly normal fl ow. It was then sewn in a side-to-side fashion to the large diagonal ramus, and then it was coursed over and was sewn end-to-side to the intramyocardial portion of the left anterior descending coronary artery. Th e patient's postoperative recovery was smooth, and 6 months later he was active and symptom free. DISCUSSIONTh e ITA, TCT, vertebral artery, and costocervical trunk make up the four major branches of the fi rst part of the SCA. Th e ITA normally arises from the anteroinferior aspect of the fi rst part of the SCA at about the same level as the TCT, which has its origin on the anterosuperior aspect of the SCA. Th e TCT has three main branches: 1) the inferior thyroid artery, 2) the transverse cervical artery, and 3) the suprascapular artery (1). Variances in the origin of both the ITA and TCT have been reported. Th e ITA has been reported to arise anomalously from the TCT as well as from each of its branches (2-4). In addition, the ITA has been reported to arise anomalously from the third intercostal artery (5), from the lateral junction of the SCA and the aorta (6), from the distal part of the SCA (2), and from the axillary artery (2) and to be unilaterally as well as bilate...

show abstract

Section: Discussionmentioning

confidence: 54%

Abnormal Origin of the Left Internal Thoracic Artery Detected Only by Computed Tomography

McMaster¹,

Blanc²,

Hamman³

et al. 2013

Baylor University Medical Center Proceedings

View full text Add to dashboard Cite

show abstract

“…Theoretically, such variations in branching may lead to future complications such as coronary or shoulder-girdle muscle steal phenomenon and kinking of the artery during CABG. 6 However, to the best of our knowledge, no such complication has been reported in the literature. It is important to recognize variant anatomy when patients are under consideration for therapeutic interventions such as CABG to help develop safe surgical procedures.…”

Section: Discussionmentioning

confidence: 81%

Bilateral variant origin of subclavian artery branches

et al. 2016

View full text Add to dashboard Cite

show abstract

“…But the presence of two separate origin of scalenus anterior muscle observed in the present study is a rare anomaly. The Internal thoracic artery is widely utilized as a great conduit for myocardial revascularization [3][4][5] and its variability in origin is of great surgical importance. A study reveals that 1% of right ITA originates from right thyrocervical trunk [6].…”

Section: Resultsmentioning

confidence: 99%

Scalenus Anterior Muscle With Two Heads Associated With Variation in the Branches of Subclavian Artery: a Rare Presentation

Perumal¹,

Shanthi²,

Srinivasan³

2018

IJAR

View full text Add to dashboard Cite

Arterial variations are quite common. Many studies had elaborated variations in branching pattern of subclavian artery. Present study illustrates a unique feature of scalenus anterior muscle having two heads of origin and a common trunk for internal thoracic artery (ITA) and thyrocervical trunk (TCT). This rare common trunk passes between two heads of right scalenus anterior. Such rare variation was not reported so far. The rarity of such variation signifies the necessity of the present study. On the left side all branches arose normally from subclavian artery except dorsal scapular artery which originates from second part itself instead of third part which is a quite common variation. The Internal thoracic artery is widely utilized as a great conduit for Myocardial Revascularization. This common truncal origin is of great surgical importance to Cardiothoracic Surgeons, Cardiovascular Surgeons and Interventional Therapy Radiologists.

show abstract

Abnormal origin of internal thoracic artery from the thyrocervical trunk: surgical considerations

Cited by 15 publications

References 31 publications

Abnormal Origin of the Left Internal Thoracic Artery Detected Only by Computed Tomography

Abnormal Origin of the Left Internal Thoracic Artery Detected Only by Computed Tomography

Bilateral variant origin of subclavian artery branches

Scalenus Anterior Muscle With Two Heads Associated With Variation in the Branches of Subclavian Artery: a Rare Presentation

Contact Info

Product

Resources

About