A Study of Internal Thoracic Arteriovenous Principal Perforators by Using Multi-detector Row Computed Tomography Angiography

Objective: There are numerous reports of perforating branches from the intercostal spaces of the internal thoracic vessels. These branches have varying diameters, and a main perforating branch, the principal perforator, most often found in the second or third intercostal space. We report different results based on multi-detector row computed tomography. Methods: We evaluated 121 sides from 70 women scheduled for breast reconstruction with free lower abdominal skin flaps who underwent preoperative multi-detector row computed tomographic scan between June 2008 and June 2015. For primary reconstruction, we analyzed both sides, and for 1-sided secondary reconstruction, we analyzed only the unaffected side. We evaluated both early arterial phase and late venous phase 5-mm horizontal, cross-sectional, and volume-rendering images for perforation sites and internal thoracic arteriovenous perforating branches’ intercostal space thickness. We analyzed differences in thickness between the internal thoracic arteries and veins and symmetry in cases involving both sides. Results: Venous principal perforators nearly always perforated the same intercostal spaces as accompanying veins of arterial principal perforators (99.2%), forming arteriovenous principal perforators. We found 49 principal perforators in the first intercostal space (37.4%), 52 in the second intercostal space (39.7%), 23 in the third intercostal space (17.6%), 6 in the fourth intercostal space (4.6%), and 1 in the fifth intercostal space (0.7%). Of the 51 cases in which we studied both sides, 25 cases (49%) had principal perforators with bilateral symmetry. Conclusions: In contrast to findings from past reports, we found that internal thoracic arteriovenous principal perforators were often present in almost the same numbers in the first and second intercostal spaces.