Korean J Radiol.  2003 Sep;4(3):179-183. 10.3348/kjr.2003.4.3.179.

Internal Thoracic Artery Collateral to the External Iliac Artery in Chronic Aortoiliac Occlusive Disease

• Kim J
• Won JY
• Park SI
• Lee DY

• KMID: 754022
• DOI: http://doi.org/10.3348/kjr.2003.4.3.179

Abstract

OBJECTIVE
To evaluate the incidence and angiographic findings of the collateral pathway involving the internal thoracic artery in patients with chronic aortoiliac occlusive disease. MATERIALS AND METHODS: Between March 2000 and Februrary 2001, 124 patients at our hospital underwent angiographic evaluation of chronic aortoiliac occlusive disease, and in 15 of these complete obstruction or severe stenosis of the aortoiliac artery was identified. The aortograms and collateral arteriograms obtained, including internal thoracic arteriograms, as well as the medical records of the patients involved, were evaluated. RESULTS: In nine patients there was complete occlusion of the infrarenal aorta, or diffuse stenosis of 75% or more in the descending thoracic aorta, and in the other six, a patent aorta but complete occlusion or stenosis of 75% or more of the common iliac artery was demonstrated. Collateral perfusion via hypertrophied internal thoracic arteries and rich anastomoses between the superior and inferior epigastric arteries, reconstituting the external iliac artery, were noted in all fifteen patients, regardless of symptom duration, which ranged from six months to twelve years. CONCLUSION: In patients with chronic aortoiliac occlusive disease, the internal thoracic artery, along with visceral collaterals and those from the contralateral side, is one of the major parietal collateral pathways.

Keyword

Arteries, internal thoracic; Aorta, stenosis or obstruction; Angiography

Figure

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  Fig. 1 A 63-year-old man with atherosclerosis. A. Aortogram reveals infrarenal aortic obstruction. B. Aortogram obtained after retrieval of the catheter to the ascending aorta shows left subclavian arterial obstruction (arrow) and a hypertrophic right internal thoracic artery (arrowheads). C. Selective right internal thoracic arteriogram depicts mediastinal collaterals from the right to the left internal thoracic artery (arrow). D, E. Selective right internal thoracic arteriogram demonstrates rich anastomosis between the superior and inferior epigastric artery, reconstituting the external iliac artery on both sides (arrows).

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  Fig. 2 Schematic view of Fig. 1. In a patient with total occlusion of the infrarenal aorta and left subclavian artery, the internal thoracic artery provided total collateral perfusion to both lower extremities via the superior and inferior epigastric artery to the external iliac artery. The internal thoracic artery also provided perfusion to the opposing side via mediastinal collaterals.

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