Internal thoracic artery as a collateral source to the ischemic lower extremity

Abstract

Based on the superior long-term results, internal thoracic artery is widely used for coronary artery bypass grafting. However, the vessel can play an important role as a collateral source to the chronically ischemic lower limbs. We reported two cases who underwent simultaneous revascularization to the myocardium and lower limbs because this particular condition was anticipated. Selective angiography of internal thoracic artery was useful to determine its role before harvesting in our cases. Careful preoperative examinations and choice of surgical approach are required for such patients to avoid serious vascular complications.

Noncoronary Collateral Myocardial Blood Flow: The Human Heart’s Forgotten Blood Supply

“…The ITAs have the potential for developing collateral branches under some circumstances. It has been widely demonstrated that in cases with severe Leriche syndrome or with chronic obstruction of the abdominal aorta, the ITAs can evolve into the main or even sole source of blood to the lower limbs [ 60 - 68 ]. The latter occurs by virtue of the superior epigastric terminal branch, which shunts blood flow to the inferior epigastric arteries, which then anastomose with the external iliac arteries, eventually bypassing the aortic obstruction.…”

Anatomical significance in aortoiliac occlusive disease

“…The slow development of these lesions allows for this collateral network to provide enough blood flow to meet the metabolic demands of the lower extremities (Reddy and Shepard, 2006). The significance of even a minor contributor to the collateral circulation, the internal thoracic artery, is demonstrated in several cases in the literature (Prager et al, 1977;Tsui et al, 1995;Arnold et al, 2000;Hayashida et al, 2000;Kim et al, 2003;Yurdakul et al, 2006;Ferrer et al, 2007;Picquet and Enon, 2008;de Heer et al, 2011).…”