The Internal Jugular Vein Maintains its Regional Anatomy and Patency After Carotid Endarterectomy: A Prospective Study

Abstract

ObjectiveTo validate the authors' published surface landmarks for gaining percutaneous access to the internal jugular vein (IJV), and to determine whether these surface landmarks were altered after neck surgery. Summary Background DataCarotid puncture and pneumothorax continue to be the most frequent mechanical complications of percutaneous IJV venipuncture, particularly when the anterior or posterior approaches are used. The authors' modified technique of IJV venipuncture was associated with a 0.6% complication rate; notably, there were no instances of carotid artery puncture. Determining the accuracy of this method using duplex ultrasound would enhance the technique's applicability and safety. The authors also hypothesized that previous neck surgery would alter the regional anatomy in relation to these surface landmarks for IJV venipuncture. MethodsThe authors prospectively evaluated 417 IJVs in 209 consecutive patients undergoing carotid duplex imaging before and after carotid endarterectomy (CEA). Patients who had undergone CEA were enrolled to investigate the effect of neck surgery on IJV anatomy. The opposite, nonoperated side of the neck served as a control for each patient. The position of the IJV in relation to the surface landmarks, the mobility of the IJV on neck rotation, and the size, patency, and relation of the IJV to the carotid artery were evaluated. ResultsOverall accuracy of the surface landmarks for locating the IJV percutaneously was 99% for the control group and 95% for the CEA group. With neck rotation, the IJV was located in a more lateral position in relation to the landmarks that would significantly reduce its accessibility. After neck rotation, it was also noted that the carotid artery moved behind the jugular vein in 85% of the patients in both groups. The mean size of the vein and its patency were similar in both groups. ConclusionsDuplex imaging validated the accuracy of the surface landmarks for IJV cannulation and documented the adverse effects of neck rotation. IJV anatomy is not altered after CEA.Access to major large central veins is commonly gained percutaneously, and a thorough knowledge of the surface anatomy is essential to ensure successful venous cannulation and minimize mechanical complications. Many clinicians advocate an ultrasound probe to localize the jugular vein before venipuncture, because the success rate of this technique exceeds 95%. 1,2 We described a new method for cannulating the internal jugular vein (IJV) that we developed from the anatomical relations noted during radical neck dissections. 3 A retrospective review of our method revealed a 91% success rate of IJV cannulation and a complication rate of 0.6%. 3 We used duplex imaging to determine the reliability of surface landmarks in locating the IJV. Percutaneous cannulation of the ipsilateral IJV has historically been considered

Chronic Cerebrospinal Vascular Insufficiency Is Not Associated with HLA DRB1*1501 Status in Multiple Sclerosis Patients

“…Female gender, older age, and pregnancy are risk factors for chronic venous diseases [24] and women have greater frequency of variant hepatic veins [25] . Women have also been reported to have a smaller internal jugular vein size than men (1.48 for men vs. 1.27 in women) [26] . Venous malformations may have genetic contributions and a “double-hit” mechanism has been invoked to explain incomplete penetrance and variability [27] , [28] .…”

Anatomical variations of the internal jugular veins and their relationship to the carotid arteries: A CT evaluation

“…Variations in these imaging techniques, operator difference and neck rotation could produce significant differences in assessment of IJV–carotid correlations. Studies have also shown that contralateral head rotation altered the anatomical correlation of the IJV to carotid artery and increased the risk of inadvertent carotid puncture 5,13 . The need for close contact of the transducer and skin surface requires external pressure, which could potentially compress and alter the parameters of the IJV.…”

Anatomic considerations for central venous cannulation

“…(The clock-dial positions are described from the perspective of the operator standing at the patient’s head and facing the patient’s feet). The right internal jugular vein was found more commonly in the 12 o’clock anterior and 1 o’clock positions in 20% of subjects, in the anterolateral 2 o’clock position in 71%, and similarly in the directly lateral 3 o’clock position in 9% 22. Very rarely, the internal jugular vein lies medial to the carotid artery.…”