title: Posterior intercostal artery tortuosity and collateral branch points: a cadaveric study.
abstract: Publications report observing tortuosity in the posterior intercostal arteries of  elderly patients. Studies also describe the size and course of the collateral intercostal  arteries. This information is clinically significant when performing thoracentesis  and video-assisted thorascopic surgery. To the best of our knowledge,  no studies have examined arterial tortuosity or described collateral artery origins  relative to bony landmarks. The purpose of this study was to define a safe  surgical zone for thoracic access using palpable external bony landmarks.  A total of 348 intercostal spaces (3rd-8th) of 29 male and female embalmed cadavers  were dissected from the vertebral body to the mid-axillary line to observe  the posterior intercostal artery and its collateral branch. The origins of the  collateral intercostal arteries relative to the midline of thoracic spinous processes  were measured. Mild to moderate tortuosity (arterial curves covering 25-  -50% of the intercostal space) was observed in at least one posterior intercostal  artery in the majority of cadavers. The origins of the collateral intercostal arteries  were variable relative to the midline. Additional collateral intercostal arteries  distal to the primary collateral branch were observed, most commonly in  the 5th intercostal space, which is used in video-assisted thorascopic surgery  and thoracentesis. Tortuosity is common in the 3rd to the 8th posterior intercostal  arteries, especially in individuals over the age of 60 years. Given the findings  of this study, we recommend that any procedure involving placement of a surgical  instrument into these intercostal spaces does so at least 120 mm lateral to the  midline of the spinous processes. We also recommend pre-procedure ultrasound  (intercostal scan) of the posterior and collateral intercostal arteries when performing  non-emergent thoracentesis and video-assisted thorascopic surgery, particularly  in patients over 60 years of age.
authors.affiliation: Kansas City University of Medicine and Biosciences, Kansas City, MO, USA.
authors.forename: E
authors.initials: E
authors.lastname: Shurtleff
authors.forename: A
authors.initials: A
authors.lastname: Olinger
mesh_terms: D000368:Aged; D001158:Arteries / Q000002:abnormalities / Q000033:anatomy & histology* / Q000601:surgery; D002102:Cadaver; D004210:Dissection; D005260:Female; D006491:Hemothorax / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D007366:Intercostal Muscles / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019616:Thoracic Surgical Procedures; D035441:Thoracic Wall / Q000098:blood supply* / Q000601:surgery