An anterior jugular vein variant in a patient requiring tracheostomy, demonstrating the importance of preoperative/procedural ultrasound

Abstract

A 50-year-old woman was admitted to the intensive care unit (ICU) for a life-threatening exacerbation of asthma requiring intubation and ventilation for 7 days. On day 8, she was stepped down from the ventilator via the insertion of a tracheostomy to aid weaning. It was initially decided that a percutaneous tracheostomy would be attempted on ICU, however, following further consideration, it was decided that due to anatomical factors (short neck) a surgical tracheostomy would be performed by the ear, nose and throat (ENT) team. A periprocedural USS was not performed. At surgery, instead of identifying two superficial anterior jugular veins lying on each side of the trachea, one large anterior jugular vein (median vein) was found overlying the entire anterior surface of the trachea. Had a PCT been attempted without an ultrasound scan being performed, this vessel would have been punctured, creating a significant bleed that could have placed the patient's airway and/or circulatory system at risk.

Anatomical Characteristics of the Anterior Jugular Vein and Its Clinical Relevance

“…[1][2][3][4][5][6][7][8][9][10] Neck ultrasonography helps determine the location and characteristics of the AJV and jugular venous arch before a surgical treatment. 2,4,6 In this Korean cadaveric study, no significant difference in anatomical characteristics was found according to gender or AJV variation except for a difference in the length of the neck according to gender. However, through this study, it was possible to find a safety zone at the main landmark of the neck that could avoid AJV damage (Fig.…”

“…Therefore, to avoid AJV damage, surgeons should be fully familiar with anatomical features of the AJV before initiating head and neck surgical procedures. 1–10 Neck ultrasonography helps determine the location and characteristics of the AJV and jugular venous arch before a surgical treatment. 2,4,6…”

“…[1][2][3][4] However, various anatomical variations can occur in AJV. [2][3][4][5]9 The most common variant is a single AJV format instead of a pair of AJVs. 2,4 In this study, single AJV was found at a high frequency of 23.5%.…”

“…If anatomical characteristics of AJV are not known, severe bleeding can occur during various surgical procedures in the head and neck. 1–4,6–8 Furthermore, CO 2 embolism can occur after AJV injury in transoral thyroidectomy. It can lead to cardiac arrest in severe cases.…”

“…1–10 Neck ultrasonography helps determine the location and characteristics of the AJV and jugular venous arch before a surgical treatment. 2,4,6…”