Blood supply of the sternum and its importance in internal thoracic artery harvesting.
BACKGROUND
The internal thoracic artery (ITA) is the conduit of choice in coronary bypass grafting, due to the excellent long-term results achieved using it. However, increased incidence of sternal infections after pedicled ITA harvesting has revived interest in the morphology of sternal blood supply. Our aim was to discuss the topography of the sternal branches with emphasis on internal thoracic artery harvesting.


METHODS
This study was conducted on 50 fresh specimens of the anterior thorax wall. Radio-opaque material was injected and angiograms of the ITA were performed. Subsequently, the specimens were preserved and a dry dissection of each ITA and its branches was carried out.


RESULTS
In dry dissected specimens, four types of vessels were identified that have the potential to carry blood to the sternum after harvesting the ITA. In the first group, the artery to the sternum also supplies the intercostal space. In the second morphologic variant, the sternal branch gives off the perforating and anterior intercostal arteries. In the third group, we classified the common branch of the sternal and perforating arteries. In the fourth group, the sternal artery originated from the ITA as an independent branch.


CONCLUSIONS
For sternal-intercostal, perforating-intercostal, and sternal-perforating branches to function as collaterals after ITA harvesting, the common trunk of origin must remain intact. Based on morphologic data, we recommend ligating the common trunk as close as possible to the ITA; in this way, collateral blood flow to the sternum remains intact.
Berdajs
Denis
D
Department of Cardiovascular Surgery, University Hospital Züric, Zürich, Switzerland. denis.berdajs@usz.ch
Zünd
Gregor
G
Turina
Marko I
MI
Genoni
Michele
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016063:Blood Loss, Surgical; D002648:Child; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D008026:Ligation; D008297:Male; D008323:Mammary Arteries / Q000033:anatomy & histology / Q000601:surgery*; D008875:Middle Aged; D013249:Sternum / Q000098:blood supply*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*