Bilateral origin of the internal thoracic artery from the third part of the subclavian artery: A case report

The routine use of the internal thoracic artery (ITA) as a conduit in coronary artery bypass grafting surgery has highlighted the need to appreciate this vessel's anatomic variations. The usual origin of this vessel is from the first part of the subclavian artery, occasionally from the second and rarely from the third. Henriques-Pino and Prates described a unilateral origin from the third part on the left and Vorster et al on the right. Our cadaveric case report presents an unusual bilateral origin of the ITA arising from the third part of the subclavian artery in a 25-year-old Black South African female. The ITA arose from the ventral aspect, 7.3 cm on the right side and 8.5 cm on the left side from the origin of the subclavian artery, and inclined acutely interiorly and medially, anterior to the distal attachment of the scalenus anterior m., followed the inner border of the first rib for a short distance and, thereafter, continued its usual course in the thorax. This appears to be the first case report presenting a bilateral origin of the ITA from the third part of the subclavian artery.