Computed Tomographic Angiography-Assisted Vascular Assessment of Internal Mammary Vessels

PURPOSE - The internal mammary (IM) vessels are important recipients in autologous, free flap breast reconstruction. These vessels are preferred recipients due to their caliber, central positioning, and avoidance of axillary scarring. To date, current literature regarding the effects of vascular comorbidities on IM vessel caliber is non-existent. The purpose of this study is to provide anatomical data of these vessels using computed tomographic angiography (CTA).

METHODS - A review of IM vessels was completed in 110 CTA studies of female patients with breast masses, and pulmonary processes. Internal mammary vessel calibers were taken at the second and third intercostal spaces.  Patient demographics and comorbidities were reviewed.

RESULTS – The right IM artery and vein had a significantly larger caliber than the left side in all intercostal spaces (p = 0.02 and p < 0.001, respectively). A positive, statistically significant correlation was found between both skeletal chest width and BMI with IM vessel caliber at all intercostal spaces, bilaterally (p = 0.02, p ≤ 0.05, respectively). There was no significant difference in IM vessel caliber in patients with hypertension or hyperlipidemia. However, the left IMA at the second intercostal space was significantly larger in diabetic individuals than in non-diabetic individuals (p = 0.01).

CONCLUSIONS – Understanding the anatomy and caliber of IM vessels can help preoperative planning of autologous, free flap breast reconstruction. Body mass index has a significant, positive correlation with internal mammary arterial and venous caliber, which may have positive effects on vascular anastomoses in breast reconstruction.