Cardiac Surgery

October / 2017
 Each of the subclavian arteries is made up of three parts, defined
in relation to the Anterior scalene muscle.

First part
lies medial to the anterior scalene muscle.
First part branches include: Vertebral artery , Internal thoracic artery
and Thyrocervical trunk

Second Part
lies posterior to the anterior scalene muscle.
It gives rise to the costocervical trunk .

Third Part
lies lateral to the anterior scalene muscle.
Ends at the outer border of the 1st rib by forming the axillary artery
ORIGIN and Course Of IMA
Originates from 1st part of the subclavian artery , opposite
the thyrocervical trunck and medial to the scalenus
anterior muscle.

Crossed anteriorly by the brachiocephalic vein before

reaching the first rib (risk of injury).

It descends into the thorax behind the 1st costal cartilage

and in front of the pleura.

It descends vertically one fingerbreadth lateral to the

sternum.
 It Coveres by the intercostal cartilage and the internal
intercostal muscle

At the 3rd intercostal space, it continues to run

inferiorly but now superficial to the transversus
thoracis muscle.

In the 6th intercostal space, it divides into the

superior epigastric and the musculophrenic
arteries.
 BRANCHES
Thymic Artery

Thin artery branches off at the

level of the first intercostal space

Usually only present in children

Turns into a fibrotic residue in adults

The Xiphoid branch
a small bilateral branch
Passes in front of xiphoid
Anastomosis with the opposite artery
The sternal branches
Distributed in each intercostal
space
The main source of the sternal
blood supply.
The Pericardiacophrenic branch
Accompanies the phrenic nerve

Runs toward the diaphragm

supplies the pericardium

Anterior intercostal branches
Arise in the uppermost five intercostal spaces
Perforating branches
Contribute to the blood supply of the sternum, skin,
pectoral muscles, and breast.
accompany the terminal branches of the corresponding
intercostal nerves
Musculophrenic artery

The lateral end branch

which runs around the costal margin of the diaphragm
supplies the lower intercostal spaces and the diaphragm

Superior Epigastric Artery

The medial terminal branch

enters the rectus sheath of the anterior abdominal wall and

supplies the rectus muscle as far as the umbilicus
Clinical significance
Use in bypass grafts

The internal thoracic artery is the cardiac surgeon's

blood vessel of choice for coronary artery bypass
grafting.

The left ITA has a superior long-term patency to

saphenous vein grafts and other arterial grafts (e.g.
radial artery, gastroepiploic when grafted to the left
anterior descending coronary artery, generally the
most important vessel, clinically, to revascularize.