An Unusual Termination of Seven Veins in the Jugulo-Subclavian Junction

Abstract

SUMMARY:During anatomical dissection of a female Caucasian cadaver in our department, we observed an unusual termination of seven veins at the jugulo-subclavian junction. Normally, the jugulo-subclavian junction is formed by the union of the internal jugular vein and the subclavian vein, and gives rise to the brachionocephalic vein. In our case, except from these two, five additional veins, namely the cephalic vein, the transverse cervical vein, the external jugular vein, the anterior jugular vein, and the vertebral vein, were also joined at the level of the jugulo-subclavian junction, in order to form the brachionocephalic vein. Such a variation has not yet been reported in the literature. INTRODUCTIONThe jugulo-subclavian junction is formed at the base of the neck bilaterally, posterior to the sternal end of the clavicle, by the union of the internal jugular vein (IJV) and the subclavian vein (SCV) (Calen et al., 1986). From this confluence the brachionocephalic vein (BCV) is formed. Then, the left and right BCV are joined in order to form the superior vena cava. In the present study we report a case in which at the level of the jugulo-subclavian junction, seven veins instead of two are joined in order to form the brachionocephalic vein. MATERIALS AND METHODThe reported anatomical variations were discovered in the right side of a female Caucasian cadaver (deceased at the age of 89 from respiratory insufficiency), during routine educational dissection at the Anatomy Department of the Medical School of the University of Athens, Greece. RESULTSOn the right upper arm and posterior to the sternal end of the clavicle we discovered that seven veins were united in order to form the right BCV vein (Fig. 1). Dissecting the area from the acromial end of the clavicle to the base of the neck (supraclavical triangle), we noticed that four veins joined the SCV in the following order (clockwise, seen from the front): the cephalic vein (CV), the transverse cervical vein (TCV), the external jugular vein (EJV) and the anterior jugular vein (AJV) (Fig. 2). The next vein to join the junction was the internal jugular vein (IJV), following its expected course. The last vein to reach the common junction was the vertebral vein (VV) (also clockwise). It should be pointed out, that the CV, after piercing the clavipectoral fascia, did not join the axillary vein as usual, but instead, crossed over the clavicle and ended at the common junction. Also, the AJV was rather thick and was larger than the EJV and the IJV. Accordingly, the right BCV vein was formed after the junction from all these veins. Its length was 5.8 cm and after its formation, continued its course as expected. The course of the other seven veins was also normal (except CV) until the point of the junction.Department of Anatomy, Medical School, University of Athens, Greece. 1259 has even the double diameter (Standring et al., 2008). The EJV has been found to flow in the jugulo-subclavian junction in the anatomical study of Deslaugiers et al. (1994) on 50 cadavers in 60%, ei...

Multiple variations of superficial and deep veins in the neck region of a cadaver: a case report

“…Communicating veins may compensate the drainage of veins which are inadequate in size or width as a result of developmental disorders in the region and these veins are usually branches of the common facial vein. [11] Panagouli et al [2] reported that the CV, the TCV, the EJV, the AJV, the IJV and the VV opened to the junction in a clockwise direction on the right side of the neck during cadaver dissection. In our case, it was again clockwise; anteriorly, the common trunk of the EJV and the FV, SCV, the IJV, and posteriorly the SSV combined to form the jugulo-subclavian confluence.…”

“…The anterior connection retracts to form the anteri- The PAV opens to the posterior connection and forms the posterior root of the RMV and drains into the SCV. [2,19] As a result of selective expression or arrest during development in the embryo, abnormal or extra connections between the vessels may occur and cause different images of venous drainage of the region. [6] The connections between the vessels usually occur at the 40 mm stage and sometimes occur early at the 22 mm stage, this situation causes the vessel variations.…”

“…Moreover, they have variable connections with each other and variable drainage patterns. [1,2] The information regarding veins of the head and neck depend on commonly observed patterns and generalized definitions. [2,3] The main veins of the neck are the external jugular vein (EJV), the internal jugular vein (IJV) and the anterior jugular vein (AJV).…”

“…[1,2] The information regarding veins of the head and neck depend on commonly observed patterns and generalized definitions. [2,3] The main veins of the neck are the external jugular vein (EJV), the internal jugular vein (IJV) and the anterior jugular vein (AJV). The retromandibular vein (RV) is formed by union of the superficial temporal vein (STV) and the maxillary vein (MV) within the parotid salivary gland and in here it is divided into the anterior and posterior roots.…”

A case of malpositioned catheter via supraclavicular approach for subclavian vein cannulation: A rare technique revisited

“…These superficial veins serve as collaterals and may become prominent in cases of deep venous outflow obstruction. [ 8 ]…”