Size of the collateral intercostal artery in adults: anatomical considerations in relation to thoracocentesis and thoracoscopy

Abstract

No detailed descriptions exist of the collateral intercostal artery which can provide an accurate anatomical basis for ensuring a low rate of vascular complications during thoracocentesis and thoracoscopy. Consequently the present study was undertaken to provide information on the origin, size and topographic relationships of the collateral intercostal artery. Ninety cadaveric adult intercostal spaces were dissected using standard procedures. The collateral intercostal arteries were exposed throughout their full length and measured at the points within the intercostal spaces considered to be the most important for clinical purposes. The posterior intercostal arteries and their collateral branches were observed to decrease in size from posterior to anterior; however, no significant differences were present in their size in the first four intercostal spaces. Based on these findings the usual thoracocentesis or thoracoscopy technique, in which it is recommended that puncture is done as close as possible to the superior margin of the inferior rib, may lead to collateral intercostal artery laceration and considerable bleeding. A subtle, but important, modification to this technique is suggested aimed at achieving safer access to the intercostal space. In the modified technique, the puncture should be made in the middle of the intercostal space, thereby reducing the possibility of laceration of the collateral intercostal artery.

Neurovascular anatomy and variation in the fourth, fifth, and sixth intercostal spaces in the mid-axillary line: A cadaveric study in respect of chest drain insertion

“…This has been taken as a Safe Zone given the classical position of the intercostal neurovascular bundle in the subcostal groove, thus safely superior to the incision. Our data, together with a study published previously (Da Rocha et al, 2002), suggests that this is not the safest place. The correct Safe Zone should be between 50-70% of the way down an intercostal space to avoid the varyingly positioned superior intercostal neurovascular bundle and the inferior collateral artery.…”

“…We are not attempting to comment on the frequency of occurrence of the veins, arteries and nerves in the principal neurovascular bundles. The nature of the collateral arteries has been reported elsewhere (Da Rocha et al, 2002). To achieve the aim of our study, the important goal was accurate recording of position, even at the expense of identifying every structure.…”

“…Modification of this technique to use the middle of the space has been suggested to avoid damage to collateral intercostal arteries that run along the inferior rib (Da Rocha et al, 2002). Variation in the position of the intercostal nerve posteriorly has also been described with respect to intercostal nerve blocks (Hardy, 1988).…”

Thoracic Ultrasound Demonstrates Variable Location of the Intercostal Artery

“…A study of thoracic aortograms [25] showed that the degree of tortuosity of the ICA increased with age, especially in those >60 years old where its appearance could be almost sinusoidal. Finally, an additional vessel located in the inferior region of the ICS, the collateral artery, has been reported in cadaveric dissection studies [24,26]. In all cases, a collateral artery arose from the ICA between the corresponding vertebra and angle of the rib, and could be as large as the ICA.…”

Examination of the recommended safe and unsafe zone for placement of surgical instruments in thoracentesis and video-assisted thoracic surgery: a cadaveric study

“…The major cause of haemothorax in thoracentesis is laceration of the posterior intercostal artery or its collateral branches [9,12]. Reports of intercostal artery laceration and subsequent haemothorax have existed in the literature since 1970 [2], but at present there is no comprehensive description of the posterior intercostal and collateral vascular anatomy [3]. Another procedure gaining popularity among clinicians for resection of lung tumours is video-assisted thoracic surgery (VATS).…”