Anatomic variations of the phrenic nerve at the superior thoracic aperture (thoracic inlet): Implications for the cardiothoracic surgeon

摘要: Routine use of the internal thoracic (mammary) artery (ITA) in coronary revascularization has prompted surgeons to seek ways increase its length and mobility while avoiding phrenic-nerve (PN)injury related dissection ITA origin. Because no clear anatomic description PN/ITA relationship exists, we investigated course PN through superior aperture (thoracic inlet) proximity origin 51 cadavers. The coursed posterior anterior as it crossed subclavian vein PN, passing between vein, was lateral (100%). superior/inferior position is variable. passed medial (66%) but not consistent from side same cadaver. inferior IMA right hemithorax (27%) left (40%). A bilateral superior/medial found 50% cadavers a inferior/lateral one 20%. surgical implications this finding are that vulnerable injury when passes carried past border vein; 1 cm soft tissue will protect if ends at vein.