A lateral costal artery complicating video-assisted thorascopic
surgery (VATS) pleurectomy
Jeremy L. C. Smelt
Received: 20 October 2016 / Accepted: 28 November 2016 / Published online: 9 December 2016
Ó Springer-Verlag France 2016
Abstract The lateral costal artery is a rare variant arising
from the internal thoracic artery (ITA). It has been asso-
ciated with steel syndrome after coronary artery bypass
using the ITA as a conduit. Clinically, it is under-reported
in the literature. We report the presence of a prominent
lateral costal artery, coursing below the diaphragm, dis-
covered during video-assisted thorascopic surgery pneu-
mothorax surgery and preventing parietal pleurectomy.
Keywords Anatomy Á Thoracoscopy/VATS Á Pleura Á
CABG Á Arterial grafts Á Artery Á Arteries
The lateral costal artery (LCA) has been known by many
names in anatomical history including the accessory
internal mammary/thoracic artery, lateral infracostal artery
and the retrocostal artery .
The incidence of this artery varies in different ethnic
groups, however, most cadaveric studies have demon-
strated its existence from 1.5 to 3.5% [4, 6]. The clinical
signiﬁcance of the LCA has been related to angina post
coronary artery bypass grafting and it has been held
responsible for causing a steal syndrome, diverting blood
away from the internal thoracic artery (ITA) and its coro-
nary anastamosis [3, 5, 8]. The function of this accessory
artery is not known but speculation surrounds its course
along the milk line and use to supply the breast . The
artery has varied anatomy but tends to arise 2.5 cm along
the course of the ITA and terminates at the level of the
4–6th intercostal space becoming continuous with the
intercostal vascular bundle at this level .
We report the presence of a prominent lateral costal
artery, coursing below the diaphragm, discovered during
VATS pneumothorax surgery and preventing parietal
pleurectomy. This case highlights the importance of this
anatomical variation especially in the context of thoracic
surgery to avoid bleeding during pleurectomy pleurodesis.
A 25-year-old man who was a light smoker of both
tobacco and cannabis suffered two episodes of left-sided
primary spontaneous pneumothorax. He was otherwise ﬁt
and well. The patient was referred for consideration of
Left VATS bullectomy and pleurectomy. At surgery, on
insertion of a thoracope, the anomalous artery alongside
its vena communicantes was discovered (Figs. 1, 2, 3).
Apical bullectomy was performed; however, pleurodesis
was achieved via Talc insufﬂation as parietal pleurectomy
could have caused damage to the vessel and subsequent
The patient recovered well from surgery. Postoperative
radiograph was satisfactory after chest drain removal and
the patient was discharged on the third post operative day.
He was reviewed in the outpatient clinic 2 weeks post
operatively and discharged to his GP.
& Jeremy L. C. Smelt
Department of Cardiothoracic Surgery, Guy’s Hospital, 6th
Floor Tower Wing, London SE1 9RT, UK
Surg Radiol Anat (2017) 39:921–923