Internal Thoracic Vein

vena thoracica interna

The internal thoracic veins (internal mammary veins) are paired venae comitantes that accompany the internal thoracic artery on the inner surface of the anterior chest wall. They typically drain into the brachiocephalic vein on each side. The veins receive anterior intercostal tributaries and the musculophrenic and superior epigastric veins, mirroring the arterial territory of the ITA.

Region: Chest

Clinical Relevance

Clinical Notes

The internal thoracic vein is used as the outflow vessel for free flap anastomoses in breast reconstruction after mastectomy, particularly when the thoracodorsal or lateral thoracic vessels are unavailable. The vein is accessed through the second or third intercostal space adjacent to the sternum via a parasternal approach or through the chest wall by removing a small segment of costal cartilage.

Pathology

Common Injuries & Conditions

ITV Injury in Parasternal Procedures

Mediastinal biopsy, parasternal intercostal drain placement, or anterior mediastinoscopy risks injury to the internal thoracic vein, causing venous haemorrhage that is usually controlled with direct pressure or suture ligation but can be profuse given the vein's size.