a venous arch : connector of the internal thoracic veins

CLINICAL VIGNETTE A Venous Arch: Connector of the Internal Thoracic Veins MADHUR GUPTA, * LAVINA SODHI, AND DAISY SAHNI Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India Key words: venous arch; internal thoracic vein; xiphoid process VIGNETTE The internal thoracic vein (ITV) is formed by the venae comitantes of the internal thoracic artery (ITA) that unite opposite the third costal cartilage to form a single vein that usually lies medial to the ITA. The tributaries of the ITV correspond to the branches of the ITA (Williams et al., 1995). During 30 routine dissections of the anterior thoracic wall, it was observed that the medial venae comitantes were connected to each other by a transverse, oblique, U- or V-shaped venous arch, anterior to the xiphisternal joint in all the specimens (Figs. 1–3). This arch is a venous connector of the right and left medial venae comitantes of the ITAs, and no artery accompanied it. When the sternocostal head of the pectoralis major muscle was removed, the lateral ends of the venous arch could be seen entering the thorax between the xiphoid process and seventh costal car- tilages. During median sternotomy, venous bleeding may be stopped by compressing this venous arch. *Correspondence to: Dr. Madhur Gupta, Professor and Head, De- partment of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India. E-mail: [email protected] Received 28 December 2002; Revised 5 August 2003 Published online in Wiley InterScience (www.interscience.wiley. com). DOI 10.1002/ca.10227 Fig. 1. Dissection of the anterior aspect of the anterior thoracic wall showing a U-shaped venous arch anterior to the xiphisternal joint. XP, biﬁd xiphoid process; S, sternum; 7r, 7th rib; V, venous arch. Fig. 2. Dissection of the posterior aspect of the anterior thoracic wall where the xiphoid process has been removed. The ends of the venous arch are continuous with the medial venae comitantes of the internal thoracic arteries. Note that the right ITA has been removed. LITA, left internal thoracic artery; V, venous arch; mc, medial venae comitantes; S, sternum. Clinical Anatomy 17:364 –365 (2004) © 2004 Wiley-Liss, Inc.

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CLINICAL VIGNETTE

A Venous Arch: Connector of theInternal Thoracic Veins

MADHUR GUPTA,* LAVINA SODHI, AND DAISY SAHNI

Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Key words: venous arch; internal thoracic vein; xiphoid process

VIGNETTE

The internal thoracic vein (ITV) is formed by thevenae comitantes of the internal thoracic artery (ITA)that unite opposite the third costal cartilage to form asingle vein that usually lies medial to the ITA. The

tributaries of the ITV correspond to the branches ofthe ITA (Williams et al., 1995).

During 30 routine dissections of the anterior tho-racic wall, it was observed that the medial venaecomitantes were connected to each other by a trans-verse, oblique, U- or V-shaped venous arch, anterior tothe xiphisternal joint in all the specimens (Figs. 1–3).This arch is a venous connector of the right and leftmedial venae comitantes of the ITAs, and no arteryaccompanied it. When the sternocostal head of the

pectoralis major muscle was removed, the lateral endsof the venous arch could be seen entering the thoraxbetween the xiphoid process and seventh costal car-tilages. During median sternotomy, venous bleedingmay be stopped by compressing this venous arch.

*Correspondence to: Dr. Madhur Gupta, Professor and Head, De-partment of Anatomy, Postgraduate Institute of Medical Educationand Research, Chandigarh, 160 012, India.E-mail: [email protected]

Received 28 December 2002; Revised 5 August 2003

Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ca.10227

Fig. 1. Dissection of the anterior aspect of the anterior thoracicwall showing a U-shaped venous arch anterior to the xiphisternal joint.XP, bifid xiphoid process; S, sternum; 7r, 7th rib; V, venous arch.

Fig. 2. Dissection of the posterior aspect of the anterior thoracicwall where the xiphoid process has been removed. The ends of thevenous arch are continuous with the medial venae comitantes of theinternal thoracic arteries. Note that the right ITA has been removed.LITA, left internal thoracic artery; V, venous arch; mc, medial venaecomitantes; S, sternum.

Clinical Anatomy 17:364–365 (2004)

Page 2: A venous arch : Connector of the internal thoracic veins

REFERENCES

Williams PL, Bannister LH, Berry MM, Collins P, Dyson M,Dussek JE, Ferguson MWJ, editors. 1995. Gray’s anatomy.38th Ed. Edinburgh: Churchill Livingstone. p 1592.

Fig. 3. Schematic representation of various shapes of the venous arch anterior to the xiphisternaljoint: (a) inverted-U; (b) U-shaped; (c) oblique; (d) V-shaped; (e) transverse. XP, xiphoid process; S,sternum; 7r, 7th rib; V, venous arch.

Thoracic Venous Arch 365

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