[The internal thoracic blood vessels (internal thoracic arteries and veins) and their practical significance]. 1996

N Jelicić, and Lj Djordjević, and T Stosić
Institute of Anatomy, University School of Medecine, Belgrade.

Internal thoracic blood vessels (A. et Vv. thoracicae internae) are parietal vessels of the thoracic anterior wall. Because of their position, they are often exposed to injuries during the fracture of the ribs and the sternal bone. These facts require a general knowledge about the anatomical variations of these vessels, specifically the knowledge concerning their mutual relationship, their anastomoses and their distance from the lateral margins of the sternal bone. Due to the poor and different data in the available literature, we directed our investigations towards the study and confirmation of the described anatomical variations of the internal thoracic blood vessels. In this study we investigated the distance between the internal thoracic artery and the lateral margins of the sternal bone, the level of its bifurcation, the number of the internal thoracic veins and anastomoses between them. The investigation was carried out on 300 formalin specimens consisting of the anterior wall of the thorax (persons of different ages and sexes) by using the method of dissection and the method of contrast injection. In adults (200 specimens), the distance between the arterial trunk and the lateral margin of the sternal bone was not equal in the first fifth or sixth intercostal spaces, but in children up to five years of age (100 specimens), the distance was almost the same. In adults, the internal thoracic artery was nearest to the sternal bone in the first intercostal space, but going downward the artery was gradually more and more distant from the sternum and in the sixth intercostal space the distance measured approximately from 11 mm to 13 mm. In children, the distance of the artery from the lateral margin of the sternal bone, just in the above mentioned intercostal spaces, was from 5 mm to 10 mm. There was no difference according to sex in any of the two groups. Most frequently, the internal thoracic artery gave off its terminal branches at the level of the sixth costal cartilage (adults--35% and children--45%), and most rarely, the bifurcation of the artery was at the level of the seventh costal cartilage (adults--10% and children--8%). The internal thoracic vein that accompanies the same named artery, could be either single or double, on one or both sides. In cases of double veins-the artery was situated between the two of them, but in cases of single vein-the vein was located medially to the artery. In 82% of cases in the adult group, and in 69% of cases in the children-group, there were two veins accompanying the artery. The right and the left internal thoracic veins were connected in the region of the sternal bone by the retrosternal venous net (specifically in the region of the manubrium) and by one venous vessel lying in front of the xiphoid process. According to the position and the course of that venous vessel it could be called "arcus venosus prexiphoideus". The internal thoracic blood vessels were enclosed by the unique fascial sheath. They were superiorly separated from the costal pleura by the endothoracic fascia and inferiorly by the transversal thoracic muscle (m. transversus thoracis). The safest approach to the internal thoracic artery was at the level of the second and the third intercostal space. During the approach through some of the lower intercostal spaces it was necessary to be very careful because they could be narrowed at their anterior ends.

UI MeSH Term Description Entries
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D013895 Thoracic Arteries Arteries originating from the subclavian or axillary arteries and distributing to the anterior thoracic wall, mediastinal structures, diaphragm, pectoral muscles, mammary gland and the axillary aspect of the chest wall. Arteries, Thoracic,Artery, Thoracic,Thoracic Artery
D013909 Thorax The upper part of the trunk between the NECK and the ABDOMEN. It contains the chief organs of the circulatory and respiratory systems. (From Stedman, 25th ed) Chest,Thoraces,Chests,Thorace
D014680 Veins The vessels carrying blood away from the CAPILLARY BEDS. Vein

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