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Between the head of the rib and costovertebral angle the 
artery is located lower then its rib and can be damaged in 
thoracocentesis. From the costovertebral angle to the middle 
inguinal line the vessels go in the subcostal groove. That's why 
thoracocentesis should be done between scapular and 
posterior inguinal lines.
At the level of costovertebral angle the artery is located in 
sulcus costae, goes in the groove between mm. intercostales 
and in the middle inguinal line it anastomoses with interior 
intercostal artery, the branch of a. thoracica interna.
So, in the intercostal space is formed the arterial circle 
which consists of two arterial systems: thoracic part of aorta 
and subclavian artery. The circle is located only in the 6 upper 
intercostal spaces. In 5 inferior intercostal spaces there are 
only posterior intercostal arteries which go to the muscles of 
anterior abdominal wall with their frontal ends. They go 
through the groove between internal oblique and transverse 
muscles of abdomen. Anterior intercostal arteries branch off 
from the internal thoracic artery. 
A. thoracica interna begins in the inferior semicircle of 
subclavian artery in its first section (to penetration into spatium 
interscalenum). It goes behind v. subclavia and then goes down. 
Through apertura thoracis it goes to the cavitas thoracis and 
descends parallel the edge of cavitas thoracis at the distance of 1 –
2 cm from this cavitas thoracis edge. It goes behind the costal 
cartilages and inner intercostal muscles. It is allocated till the level 
of the 2nd costal cartilage between pleura and endothoracic fascia, 
and covered with fascia endothoracica. M. transversus thoracis is 
also covered below the 3rd costal cartilage (cartilago costalis). Near 
the diaphragm at the level of the 7th costal cartilage (cartilago 
costalis) it divides into 2 branches: a. musculophrenica and a. 
epigastrica superior.

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A. musculophrenica goes along the line of attachment of 
the costal part of the diaphragm. It gives off 5 inferior 
intercostal arteries to the muscles of intercostal spaces. It 
supplies the diaphragm and abdominal muscles with blood 
(Fig. A.8).
A. epigastrica superior breaks posterior wall of sheath of 
rectus abdominis muscle and is located on the posterior 
surface of the muscle and at the level of umbilicus it 
anastomoses with a. epigastrica inferior from a. iliaca externa. 
There are different branches along the entire length from a. 
thoracica interna. 
1. Rr. mediastinales go to the pleura, cellular tissue and 
lymph nodes of upper and anterior mediastinum. 
2. Rr. thymi go to the thymus. 
3. Rr. bronchiales and rr. tracheales go to bronchi and trachea. 
4. Rr. intercostales anteriores go to the intercostal spaces. 
5. A. pericardiacophrenica begins at the level of the 1st rib, 
accompanies n. phrenicus going along the lateral surface of the 
heart, branches off its branches to heart and anastomoses with 
other branches of heart and myocardium. 
That is why Fieschi operation and internal thoracic artery 
ligature in the 2nd intercostal space were performed for 
myocardial revascularization in ischemic heart disease. In 
recent years instead of Fieschi operation the mammary-
coronary artery anastomosis is performed. Herewith the 
internal thoracic artery is sutured to one of the coronary 
arteries. 
Venous drainage from the thoracic cage is supplied by: 
1. Vv. thoracicae internae – drain blood from the anterior 

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