Lateral costal artery: clinical importance of an accessory thoracic artery

Abstract The lateral costal artery has sometimes been identified as the culprit for the "steal phenomenon" after coronary artery bypass grafting, besides being occasionally used for myocardial revascularization. Its branches make anastomoses with the internal thoracic artery through lateral intercostal arteries. We aim to report, on three cases, the clinical significance of a well-developed lateral costal artery after coronary artery bypass grafting. Two out of three patients who underwent coronary artery bypass graft surgery in our center between June 2010 and August 2017, applied to us with stable angina pectoris, while the third one was diagnosed with acute coronary syndrome after applying to the emergency department. In coronary cineangiography, in all three cases, a well-developed accessory vessel arising from the proximal 2.5 cm segment of the left internal thoracic artery coursed as far as the 6th rib was detected, and it was confirmed to be the lateral costal artery. A stable angina pectoris in two of the patients was thought to be the result of steal phenomenon caused by the well-developed lateral costal artery. In the two cases with stable angina pectoris the lateral costal artery was obliterated via coil embolization. In the other case with the proximal left anterior descending artery stenosis, before percutaneous coronary intervention, the lateral costal artery was obliterated via coil embolization and the occluded subclavian artery was stented. Routine visualization in cineangiography and satisfactory surgical exploration of the left internal thoracic artery could be very helpful to identify any possible accessory branch of the left internal thoracic artery like the lateral costal artery.

Variaciones múltiples de las ramas de la arteria axilar relevantes para la cirugía plástica: reporte de caso / Multiple variations in the axillary arterial tree relevant to plastic surgery: a case report

While dissecting the body of a 59 years old male cadaver we observed abnormal branching pattern of the axillary artery and unusual vascular pedicles of the serratus anterior muscle. The serratus anterior branch originated directly first part of the axillary artery as the first branch. The lateral thoracic and thoracodorsal arteries arose together from the third part of the axillary artery as a lateral thoracic- thoracodorsal common trunk. The superior thoracic artery was out of the position. The circumflex scapular artery originated directly the third part of the axillary artery. The subscapular artery was not present.

Durante la diección de un cadáver de un hombre de 59 años de edad observamos un padrón anormal de las ramas de la arteria axilar e inusual pedículo vascular para el músculo serrato anterior. La rama para el músculo serrato anterior se originaba directamente de la primera parte de la arteria axilar como la primera rama. Las arterias torácica lateral y toracodorsal se originaban juntas de tronco común de la tercera parte de la arteria axilar como arteria torácica lateral-toracodorsal. La arteria torácica superior estaba fuera de la posición. La arteria circunfleja escapular se originaba directamente de la tercera parte de la arteria axilar. La arteria subescapular no estaba presente.

Anatomical variation in origin and course of the thoracoacromial trunk and its branches.

The variations in origin and course of the thoracoacromial trunk (TAT) and its branches were studied in 178 cadavers during the routine dissection from the year 1982 to 2002. The TAT originated from the first part of the axillary artery (AA) in 13.4% cases of the right and 10.6% of the left axilla. The variations in origin of the branches of TAT were divided into three groups. First variation group showed deltoacromial (DA) and clavipectoral (CP) subtrunks of the TAT originating directly from the AA in majority of cases. Second group revealed clavicular branch of the TAT originating from the AA, whereas in the third group all classical branches originated directly from the AA and there was no existence of the TAT. The superior thoracic artery (STA) originated from the TAT in 16.8% (Confidence Interval, CI: 11.12-21.89) cases of the right and 6.1% (CI: 2.59-9.53) of the left axilla and the lateral thoracic artery in 39.8% (CI: 32.01-46.10) cases of the right and 29.3% (CI: 15.01-26.80) of the left axilla. The incidence of variations in origin of the TAT and its branches was found higher on right side. The knowledge of these variations is of anatomical and surgical interest. This information is useful for the surgeons dealing with the axillary region especially in case of reconstructive surgery.

Colaterales aortopulmonares toracoabdominales y ductus arterioso permeable: hallazgos de US Doppler y embolización / Aortopulmonary thoraco abdominal vascular anomalies and persistent ductus arteriosus: US Doppler and embolization

Se presenta el caso de un caso en un recién nacido (RN) con ductus arterioso permeable asociado a colaterales arteriales pulmonares toracoabdominales detectadas con ecografía Doppler Color y tratado con embolización. Un RN prematuro que desarrolló a los 37 días de vida insuficiencia cardíaca severa y persiste con la sintomatología luego de la ligadura quirúrgica del Ductus. Fue estudiado con ecografía Doppler Color abdominal y tratado con embolización mediante coils. Se detectó inicialmente con US Doppler Color una arteria colateral infradiagfragmática. Por cateterismo, se observaron dos vasos anómalos que nacían de la Aorta cerca del origen de la arteria subclavia y un tercero que nace cerca del tronco celíaco. El retorno venoso pulmonar era normal y fue posible la embolización con coils con oclusión total de las colaterales. Los síntomas mejoraron dramáticamente luego del procedimiento. Este caso ilustra que los pacientes con insuficiencia cardíaca de etiología no clara deben ser estudiados con ecografía Doppler Color. El tratamiento de elección de arterias colaterales sistémicas anómalas es la embolización con coils, evitando cirugías