Case

During a cardiac surgery on a 38 year old female patient, the surgeon detaches the left internal thoracic artery and connects it to a coronary artery in a bypass surgery (a LITA procedure, left internal thoracic artery coronary bypass). The surgeon is unconcerned about blood supply to the chest wall or the breast.

Question 1/2 - Why is the surgeon unconcerned?

Click on your selected option(s) below  (correct = 1, over-thinking = 2+)

Incorrect. All tissues require a satisfactory oxygen and nutrient supply for survival based on the volume of tissue and metabolic activity of the tissue. Intercostal musculature is contracting with every breath and thus is quite active and bones have a substantial metabolic demand.   

Correct! The anterior chest wall is supplied by multiple anastomosing vessels, which allows for removal of one supply as the other vessels will push blood through the anastomosis into the territory of the missing supply. This happens essentially immediately as pressure rebalances in the vasculature bed within a few heartbeats.

Incorrect. Major arteries (and veins) are unable to regrow. Angiogenesis growth processes are restricted to smaller vessels only (as a rough guide, if a vessel is 'named' it's too big to undergo angiogenesis replacement). Also, ischemic tissue such as muscle/bones will die faster than vessels could regrow (peripheral tissues such as bone/fascia survive 4-6 hours with low oxygen, central nervous system tissue survives only 4-6 minutes without oxygen!).

Incorrect.  Males and female have the same vascular pattern, although the larger breast tissue in female would have a slightly larger lumen diameter to supply the extra tissue. A larger vessel would not explain why the surgeon is unconcerned by the use of the internal thoracic artery in a bypass.

Incorrect. The process the surgeon realizes will occur happens immediately in all ages of individual.