Andreou Andreas Y, Iakovou Ioannis, Vasiliadis Ioannis, Psathas Chrisovalantis, Prokovas Eftychios, Pavlides Gregory
Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
Exp Clin Cardiol. 2011 Summer;16(2):62-4.
The internal thoracic artery (ITA) is considered to be the optimal conduit for surgical coronary artery revascularization. Variations in ITA anatomy are relatively common and may impact surgical results. The ITA usually arises from the intrascalenic (first) part of the subclavian artery (SCA) and, occasionally, from the interscalenic (second) part. Origination from the extrascalenic (third) part of the SCA is rare, with a reported incidence rate of 0.5% to 1.0% in anatomical studies, and 1.5% in one angiographic study. Such an aberrant ITA descends inferomedially, anterior to the distal attachment of the scalenus anterior muscle, passes posterior to the first rib and enters the thorax, from where it follows its usual course. A patient with a five-year history of in situ grafting of the left ITA to the anterior inter-ventricular artery is presented. Coronary angiography performed because of anterior wall ischemia revealed an aberrantly arising ITA from the extras-calenic part of the SCA. The implications of this ITA variant with regard to bypass surgery, postoperative angiography and subclavian vein catheterization are discussed.
胸廓内动脉（ITA）被认为是外科冠状动脉血运重建的最佳血管 conduit。ITA 解剖结构的变异相对常见，可能会影响手术结果。ITA 通常起源于锁骨下动脉（SCA）的斜角肌内（第一）部分，偶尔起源于斜角肌间（第二）部分。起源于 SCA 斜角肌外（第三）部分的情况罕见，在解剖学研究中报告的发生率为 0.5%至 1.0%，在一项血管造影研究中为 1.5%。这种异常的 ITA 向内下走行，在胸锁乳突肌远端附着点前方，经过第一肋后方进入胸腔，然后沿其通常路径走行。本文介绍了一名将左 ITA 原位移植至前室间动脉五年的患者。因前壁缺血进行的冠状动脉造影显示 ITA 异常起源于 SCA 的斜角肌外部分。讨论了这种 ITA 变异对搭桥手术、术后血管造影和锁骨下静脉插管的影响。
