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Le TP, Le AT, Huynh TND, Huynh KQ, Dao TH, Desgranges P, Bosc R. Duplex Imaging Assessment of the Internal Mammary Arteries in Women after Unilateral Mastectomy and Radiotherapy for Breast Cancer. Ann Vasc Surg 2024; 100:15-24. [PMID: 38110082 DOI: 10.1016/j.avsg.2023.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The effects of incidental radiation exposure on internal mammary arteries remain unclear. The present study was designed to test the hypothesis by comparing diameter and blood flow of the irradiated and nonirradiated internal mammary arteries, using Duplex ultrasound imaging. METHODS The study was designed as a single-center, transversal, comparative study. The main outcomes were diameter and volumetric blood flow of the internal mammary arteries. The Wilcoxon rank-sum test was used to assess the differences between the irradiated and nonirradiated internal mammary arteries with regard to the diameter and volumetric blood flow. RESULTS The diameter (median [interquartile range]) of the irradiated internal mammary arteries (0.170 mm [0.160, 0.180]) was smaller than that of the contralateral nonirradiated ones (0.180 mm [0.170, 0.200], P < 0.0001) and that of the internal mammary arteries in the control group (0.180 mm [0.170, 0.190], P < 0.0001). Similarly, blood flow (median [interquartile range]) of the irradiated internal mammary arteries (52.4 ml/min [37.78, 65.57]) was smaller than that of the contralateral nonirradiated ones (62.7 ml/min [46.87, 84.17], P < 0.0001), as well as of the left (56.7 ml/min [46.88, 72.58], P = 0.02) and the right internal mammary arteries in the control group (61.0 ml/min [47.47, 74.52], P = 0 0.0009). CONCLUSIONS The data indicate that the irradiated internal mammary arteries in patients with a history of total mastectomy followed by radiotherapy for breast cancer had significantly smaller diameter and blood flow compared to the nonirradiated internal mammary arteries.
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Affiliation(s)
- Thanh-Phong Le
- Department of Vascular Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam; L'École Doctorale Sciences de la Vie et de la Santé (Doctoral School of Life and Health Sciences), University of Paris-Est, Creteil, France.
| | - Anh T Le
- Oncology Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tan N D Huynh
- Department of Diagnostic Ultrasonography, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Khanh Q Huynh
- Oncology Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Thu-Ha Dao
- Department of Imaging, Henri Mondor Hospital, Creteil, France
| | - Pascal Desgranges
- L'École Doctorale Sciences de la Vie et de la Santé (Doctoral School of Life and Health Sciences), University of Paris-Est, Creteil, France; Department of Vascular Surgery, Henri Mondor Hospital, Creteil, France
| | - Romain Bosc
- L'École Doctorale Sciences de la Vie et de la Santé (Doctoral School of Life and Health Sciences), University of Paris-Est, Creteil, France; Department of Plastic, Esthetic and Reconstructive Surgery, George- Pompidou Hospital, Paris, France
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Shin D, Sung KW, Fan KL, Park TH, Song SY, Roh TS, Lew DH, Lee DW. Expanding the use of internal mammary artery perforators as a recipient vessel in free tissue transfer: An anatomical analysis by computed tomography angiography in breast cancer patients. Microsurgery 2019; 39:509-514. [PMID: 30830973 DOI: 10.1002/micr.30446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 01/25/2019] [Accepted: 02/22/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The internal mammary artery (IMA) perforator has assumed recent prominence as recipient vessels in free autologous breast reconstruction. However, anatomical understanding is unclear, due to limited cadaver and clinical studies. We evaluated the usability of these vessels by evaluating perforator size, dominance, laterality, interspace location, and relationship with breast volume. METHODS A retrospective review assessed 197 female patients with breast cancer who had undergone computed tomography angiography (CTA) of the chest wall. The average age and body mass index (BMI) of patients was 49.0 ± 6.5 years and 24.2 ± 5 .8 kg/m2 , respectively. The average volume of breasts was 437 ± 190 mL. Our analysis focused on the anatomy of IMA perforator and its relationship to volume and BMI. RESULTS A total of 377 hemi-chest evaluations were performed. Most patients (95.5%) had sizeable perforating artery identified on CTA. Among all sizeable perforators identified, the mean diameter of the most dominant arterial perforator was 1.8 ± 0 .8 mm. The right hemi-chest had significantly larger perforators than the left (1.9 ± 0 .9 mm vs. 1.7 ± 0 .7 mm, p = 0.002). The first intercostal space (ICS) had a slightly greater of perforators than second ICS (34.6% vs. 29.8%, p = 0.172). However, second ICS had a greater number of most dominant perforators compared to first ICS (38.9% vs. 34.7%, p = 0.357). Perforators from first ICS emerge medial to the sternal edge and breast footprint. When dividing groups with 0-1 versus 2-3 reliable perforators, breast volume was significantly higher in the later (422.0 mL vs. 461.2 mL, p = 0.019). CONCLUSION These results are expected to encourage microsurgeons to use the IMA perforator by providing a clear anatomical roadmap.
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Affiliation(s)
- Dongwoo Shin
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
| | - Ki Wook Sung
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Tae Hwan Park
- Department of Plastic and Reconstructive Surgery, Bundang CHA Medical Center, Seongnam, Gyeonggi-do, South Korea
| | - Seung Yong Song
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
| | - Tai Suk Roh
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae Hyun Lew
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Won Lee
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
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Jeong CJ, Bae JM, Park SY, Han BK, Ko ES, Ko EY. Metastatic internal mammary lymph nodes or mimickers on parasternal ultrasonography: focusing on their distribution and depth. Acta Radiol 2018; 59:34-40. [PMID: 28403630 DOI: 10.1177/0284185117702180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Ultrasonography (US) is an important tool to evaluate the status of internal mammary lymph node (IMN). US features of metastatic IMNs could help determine when biopsy should be performed. Purpose To compare US features of metastatic IMNs to those of benign entities. Material and Methods In women with suspected IMN metastasis on US, their intercostal space (ICS) abnormalities were classified into metastatic IMN, benign IMN, and lymph node (LN) mimickers. US features, distribution, and depth of abnormalities in one ICS and involved ICS level were analyzed. Results Among 66 ICS abnormalities in 53 women, 46 were metastatic IMNs, ten were benign IMNs, and ten were LN mimickers. For metastatic IMNs, the second ICS was the most commonly involved ICS (n = 22), followed by the first (n = 13), the third (n = 8), and the fourth (n = 3). ICS level distribution of metastatic IMNs was not significantly ( P = 0.5407) different from that of non-metastatic lesions. Metastatic IMNs were predominantly seen in the posterior layer of ICS, significantly ( P < 0.0001) different from LN mimickers. Both metastatic IMNs and non-metastatic lesions were evenly distributed over the upper, middle, and lower part (in craniocaudal direction) of one ICS. Conclusion Metastatic IMNs are more likely to be found in the posterior layer of ICS. This can help distinguish them from LN mimickers. Any part (upper, middle, or lower) of one ICS in craniocaudal direction could be involved. The second ICS was the most commonly involved level.
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Affiliation(s)
- Chae Jin Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Min Bae
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Yoon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Yuan SM, Li Y, Ben YH, Cheng XF, Li DZ, Li DM, Jing H. Graft pathology at the time of harvest: impact on long-term survival. Braz J Cardiovasc Surg 2015; 29:543-51. [PMID: 25714207 PMCID: PMC4408816 DOI: 10.5935/1678-9741.20140118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 10/12/2014] [Indexed: 12/02/2022] Open
Abstract
Objective This study aims to present the graft pathology at the time of harvest and its
impact on long-term survival. Methods The remnants of the bypass grafts from 66 consecutive patients with coronary
artery disease receiving a coronary artery bypass grafting were investigated
pathologically, and pertinent predictive risk factors and survival were
analyzed. Results Medial degenerative changes with or without intimal proliferation were present in
36.8%, 37.8% and 35.6% of left internal mammary artery (IMA), radial artery and
saphenous vein grafts. There were 2 (3.0%) hospital deaths and 9 (14.1%) late
deaths. Multinomial logistic regression revealed left IMA pathological changes,
dyslipidemia, history of percutaneous transluminal coronary angioplasty/stent
deployment and Y-graft were significant predictive risk factors negatively
influencing the patients’ long-term survival. Kaplan-Meier survival analysis
revealed that the long-term survival of patients with left IMA pathological
changes were significantly reduced compared with those without (74.1% vs. 91.4%,
P=0.002); whereas no differences were noted in long-term
survivals between patients with and without pathological changes of the radial
arterial or saphenous vein grafts. Conclusion Pathological changes may be seen in the bypass graft at the time of harvest. The
subtle ultrastructural modifications and the expressions of vascular tone
regulators might be responsible for late graft patency. The pathological changes
of the left IMA at the time of harvest rather than those of the radial artery or
saphenous vein graft affect significantly longterm survival. Non-traumatic
maneuver of left IMA harvest, well-controlled dyslipidemia and avoidance of using
composite grafts can be helpful in maintaining the architecture of the grafts.
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Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, People's Republic of China
| | - Yun Li
- Department of Thoracic Surgery, Provincial Hospital Affiliated, Shandong University, Ji'nan, Shandong Province, People's Republic of China
| | - Yan Hong Ben
- Jinling Hospital, School of Clinical Medicine, Nanjing University, Jiangsu Province, People's Republic of China
| | - Xiao Feng Cheng
- Jinling Hospital, School of Clinical Medicine, Nanjing University, Jiangsu Province, People's Republic of China
| | - Da Zhu Li
- First Department of Surgery, Fourth People's Hospital of Lu'an, Lu'an, Anhui Province, People's Republic of China
| | - De Min Li
- Jinling Hospital, School of Clinical Medicine, Nanjing University, Jiangsu Province, People's Republic of China
| | - Hua Jing
- Jinling Hospital, School of Clinical Medicine, Nanjing University, Jiangsu Province, People's Republic of China
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Khoo A, Rosich-Medina A, Woodham A, Jessop ZM, Di Candia M, Malata CM. The relationship between the intercostal distance, patient height and outcome in microsurgical breast reconstruction using the second interspace rib-sparing internal mammary vessel exposure. Microsurgery 2014; 34:448-53. [DOI: 10.1002/micr.22238] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 02/11/2014] [Accepted: 02/14/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Anna Khoo
- Department of Plastic and Reconstructive Surgery; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Anais Rosich-Medina
- Department of Plastic and Reconstructive Surgery; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Amandine Woodham
- Department of Plastic and Reconstructive Surgery; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Zita M. Jessop
- Department of Plastic and Reconstructive Surgery; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Michele Di Candia
- Department of Plastic and Reconstructive Surgery; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Charles M. Malata
- Department of Plastic and Reconstructive Surgery; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
- Cambridge Breast Unit; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
- Professor of Academic Plastic Surgery; Postgraduate Medical Institute at Anglia Ruskin University, Cambridge and Chelmsford; UK
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Kubota Y, Mitsukawa N, Akita S, Hasegawa M, Satoh K. Postoperative patency of the retrograde internal mammary vein anastomosis in free flap transfer. J Plast Reconstr Aesthet Surg 2014; 67:205-11. [DOI: 10.1016/j.bjps.2013.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 09/02/2013] [Accepted: 10/07/2013] [Indexed: 11/25/2022]
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Tan O, Yuce I, Aydin OE, Kantarci M. A radioanatomic study of the internal mammary artery and its perforators using multidetector computed tomography angiography. Microsurgery 2013; 34:277-82. [DOI: 10.1002/micr.22185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 08/09/2013] [Accepted: 08/16/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Onder Tan
- Faculty of Medicine; Department of Plastic Reconstructive and Aesthetic Surgery; Ataturk University; 25240 Erzurum Turkey
| | - Ihsan Yuce
- Faculty of Medicine; Department of Radiology; Ataturk University; 25240 Erzurum Turkey
| | - Osman Enver Aydin
- Faculty of Medicine; Department of Plastic Reconstructive and Aesthetic Surgery; Ataturk University; 25240 Erzurum Turkey
| | - Mecit Kantarci
- Faculty of Medicine; Department of Radiology; Ataturk University; 25240 Erzurum Turkey
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The anatomy and variations of the internal thoracic (internal mammary) artery and implications in autologous breast reconstruction: clinical anatomical study and literature review. Surg Radiol Anat 2011; 34:159-65. [DOI: 10.1007/s00276-011-0886-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 09/28/2011] [Indexed: 11/26/2022]
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Jaffers GJ, Reiter C, Buckley CJ. Use of the internal mammary vein for access outflow in a hemodialysis fistula. Vascular 2007; 15:172-5. [PMID: 17573025 DOI: 10.2310/6670.2007.00019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A patient with occlusion of multiple central veins from both dialysis and nondialysis catheters required permanent access for hemodialysis. Magnetic resonance imaging showed a patent left innominate vein. He underwent creation of a left axillary artery to internal mammary vein transposition fistula using the basilic vein from his right arm. The fistula has required one revision for outflow stenosis and one for aneurysmal degeneration. It continues to function well 3 years after placement. The internal mammary vein is an option for outflow when permanent hemodialysis access has failed in the presence of a patent innominate vein with occluded or severely stenotic ipsilateral subclavian and jugular veins.
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Affiliation(s)
- Gregory J Jaffers
- Division of Transplantation Surgery, Scott and White Hospital, Temple, TX 76502, USA.
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Dursun M, Yekeler E, Yilmaz S, Genchellac H, Tunaci M. Mapping of internal mammary vessels by multidetector computed tomography for parasternal transthoracic intervention guidance. J Comput Assist Tomogr 2005; 29:617-20. [PMID: 16163030 DOI: 10.1097/01.rct.0000172673.17188.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To measure the distances between the internal mammary arteries (IMAs) and the sternum for determining a route for parasternal transthoracic interventions. METHODS Coronal reconstructed multidetector computed tomography images of 202 patients were evaluated to measure the distances between the IMAs and sternum at 3 levels (manubrium, midsternal corpus, and distal sternal corpus). The arrangements (2 veins-single artery or single vein-single artery) were documented. RESULTS The most frequently encountered arrangement (42.1%) was a single vein and single artery on both sides. Mean distances on the right and left sides were 10.2 and 10.1 cm at the manubrium, 14.5 and 14.3 cm at the midsternal corpus, and 17.9 and 17.5 cm at distal sternal corpus, respectively. CONCLUSION To be aware of the courses of the IMAs at different sternal levels is important during attempts at transthoracic intervention via a parasternal approach.
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Affiliation(s)
- Memduh Dursun
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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