-
Critical Care (London, England) Aug 2017The use of ultrasound (US) has been proposed to reduce the number of complications and to increase the safety and quality of central venous catheter (CVC) placement. In... (Review)
Review
The use of ultrasound (US) has been proposed to reduce the number of complications and to increase the safety and quality of central venous catheter (CVC) placement. In this review, we describe the rationale for the use of US during CVC placement, the basic principles of this technique, and the current evidence and existing guidelines for its use. In addition, we recommend a structured approach for US-guided central venous access for clinical practice. Static and real-time US can be used to visualize the anatomy and patency of the target vein in a short-axis and a long-axis view. US-guided needle advancement can be performed in an "out-of-plane" and an "in-plane" technique. There is clear evidence that US offers gains in safety and quality during CVC placement in the internal jugular vein. For the subclavian and femoral veins, US offers small gains in safety and quality. Based on the available evidence from clinical studies, several guidelines from medical societies strongly recommend the use of US for CVC placement in the internal jugular vein. Data from survey studies show that there is still a gap between the existing evidence and guidelines and the use of US in clinical practice. For clinical practice, we recommend a six-step systematic approach for US-guided central venous access that includes assessing the target vein (anatomy and vessel localization, vessel patency), using real-time US guidance for puncture of the vein, and confirming the correct needle, wire, and catheter position in the vein. To achieve the best skill level for CVC placement the knowledge from anatomic landmark techniques and the knowledge from US-guided CVC placement need to be combined and integrated.
Topics: Catheterization, Central Venous; Central Venous Catheters; Clinical Competence; Humans; Jugular Veins; Ultrasonography, Interventional
PubMed: 28844205
DOI: 10.1186/s13054-017-1814-y -
Ugeskrift For Laeger Apr 2023Pseudoaneurysms and thrombosis in the jugular vein are very rare. This case report presents a case of a 57-year-old female with a thrombosis in the internal jugular vein...
Pseudoaneurysms and thrombosis in the jugular vein are very rare. This case report presents a case of a 57-year-old female with a thrombosis in the internal jugular vein and a pseudoaneurysm in the external jugular vein. The diagnosis is often delayed due to the less-frequent occurrence of either. Ultrasound and/or computer tomographic scan are useful in the diagnostic process. Pseudoaneurysms in the external jugular vein are often benign and treatment spans from none to surgical removal. The treatment of venous thrombosis is anticoagulant medication.
Topics: Female; Humans; Middle Aged; Aneurysm, False; Jugular Veins; Thrombosis; Venous Thrombosis; Subclavian Vein
PubMed: 37114571
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Sep 2021: Launay's external carotid vein (ECV) is poorly represented in the anatomical literature, although it is an occasional satellite of the external carotid artery (ECA)....
: Launay's external carotid vein (ECV) is poorly represented in the anatomical literature, although it is an occasional satellite of the external carotid artery (ECA). We aimed to establish the incidence and morphology of the ECV. : One hundred computed tomography angiograms were investigated, and ECVs were documented anatomically, when found. : Launay's vein was found in 3/200 sides (1.5%) in a male and two female cases. In two of these cases, the ECV was a replaced variant of the anterior division of the retromandibular vein (RMV), and the facial vein (FV) ended in the external jugular vein. In the third case with the ECV, the RMV was absent and the common FV that resulted from that ECV and the FV drained into the internal jugular vein. The ECV could also appear as an accessory RMV, not just as a replaced one. Additional variants were found, such as fenestration of the external jugular vein (EJV), the extracondylar vein draining the deep temporal veins and an arterial occipitoauricular trunk. : Surgical dissections of the ECA in the retromandibular space should carefully observe an ECV to avoid unwanted haemorrhagic events. Approaches of the neck of the mandible should also carefully distinguish the consistent extracondylar veins.
Topics: Angiography; Drainage; Female; Humans; Jugular Veins; Male; Mandible; Veins
PubMed: 34577908
DOI: 10.3390/medicina57090985 -
Medicina (Kaunas, Lithuania) Mar 2023(1) : The external jugular vein (EJV) descends on the sternocleidomastoid muscle to drain deep into the subclavian vein. Anatomical variations of the EJV are relevant... (Review)
Review
(1) : The external jugular vein (EJV) descends on the sternocleidomastoid muscle to drain deep into the subclavian vein. Anatomical variations of the EJV are relevant for identification of the greater auricular nerve, flap design and preparation, or EJV cannulation. (2) : Different publications were comprehensively reviewed. Dissections and three-dimensional volume renderings of peculiar cases were used to sample the review. (3) : Different anatomical possibilities of the EJV were critically reviewed and documented: fenestrations and double fenestrations, true or false duplications, triplication, absence, aberrant origin or course, or bifurcation. Tributaries of the EJV, such as the facial and posterior external jugular veins, are discussed. The internal jugular vein termination of the EJV is also presented. (4) : Care should be taken when different morphological features of the EJV are encountered or reported.
Topics: Humans; Jugular Veins; Subclavian Vein; Face; Surgical Flaps
PubMed: 36984623
DOI: 10.3390/medicina59030622 -
Vascular Medicine (London, England) Aug 2022Thrombosis of the left internal jugular vein in an astronaut aboard the International Space Station was recently described, incidentally discovered during a research...
BACKGROUND
Thrombosis of the left internal jugular vein in an astronaut aboard the International Space Station was recently described, incidentally discovered during a research study of blood flow in neck veins in microgravity. Given this event, and the high incidence of flow abnormalities, the National Aeronautics and Space Administration (NASA) instituted an occupational surveillance program to evaluate astronauts for venous thrombosis.
METHODS
Duplex ultrasound of the bilateral internal jugular veins was conducted on all NASA astronauts terrestrially, and at three points during spaceflight. Respiratory maneuvers were performed. Images were analyzed for thrombosis and certain hemodynamic characteristics, including peak velocity and degree of echogenicity.
RESULTS
Eleven astronauts were evaluated with matching terrestrial and in-flight ultrasounds. No thrombosis was detected. Compared to terrestrial ultrasound measurements, in-flight peak velocity was reduced and lowest in the left. Six of 11 astronauts had mild-moderate echogenicity in the left internal jugular vein during spaceflight, but none had more than mild echogenicity in the right internal jugular vein. Two astronauts developed retrograde blood flow in the left internal jugular vein.
CONCLUSION
Abnormal flow characteristics in microgravity, most prominent in the left internal jugular vein, may signal an increased risk for thrombus formation in some individuals.
Topics: Astronauts; Humans; Jugular Veins; Space Flight; Thrombosis; Venous Thrombosis; Weightlessness
PubMed: 35502899
DOI: 10.1177/1358863X221086619 -
Journal of Vascular Surgery. Venous and... May 2022The aim of the present comprehensive review was to present an overview of the clinical presentation and treatment options for external (EJVAs) and internal jugular vein... (Review)
Review
OBJECTIVE
The aim of the present comprehensive review was to present an overview of the clinical presentation and treatment options for external (EJVAs) and internal jugular vein aneurysms (IJVAs) to help clinicians in evidence-based decision making.
METHODS
A systematic literature search was conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement and included MEDLINE, Embase, Cochrane Library, Scopus, WHO (World Health Organization) trial register, ClinicalTrials.gov, and the LIVIVO search portal. The inclusion criteria were studies of patients who had presented with IJVAs or EJVAs. The exclusion criteria were animal and cadaver studies and reports on interventions using the healthy jugular vein for access only (ie, catheterization). Analysis of the pooled data from all eligible case reports was performed.
RESULTS
From 1840 identified reports, 196 studies were eligible. A total of 256 patients with JVAs were reported, with 183 IJVAs and 73 EJVAs. IJVAs were reported to occur in 66% on the right side compared with the left side (P = .011). The patients with IJVAs were mostly children (median age, 12 years; interquartile range, 5.8-45.2 years). The patients with EJVAs were young adults (median age, 30 years; interquartile range, 11.0-46.5 years). EJVAs were more frequently reported in women and IJVAs in men (P = .008). Most of the patients were asymptomatic. Pulmonary embolization in association with thrombosed EJVAs was only reported for one patient. A report of the outcomes after surgery and conservative management was missing for ∼50% of the patients. No relevant complications were reported after ligation of the EJVA without reconstruction. Intracranial hypertension after ligation of the right-sided IJVA was reported in three children; in one of them, a pontine infarction was observed.
CONCLUSIONS
JVAs are a disease of the younger population but can occur at any age. It seems to be safe to observe patients with nonthrombosed JVAs. However, in the presence of thrombus or pulmonary embolization, surgical treatment should be considered. A reconstruction technique of the IJVA with venous patency preservation should be preferred.
Topics: Aneurysm; Brachiocephalic Veins; Female; Humans; Jugular Veins; Ligation; Thrombosis
PubMed: 34634519
DOI: 10.1016/j.jvsv.2021.09.009 -
The Journal of Craniofacial Surgery Jun 2020External jugular vein is formed by joining of posterior division of retromandibular vein and posterior auricular vein and common facial vein drain into internal jugular...
External jugular vein is formed by joining of posterior division of retromandibular vein and posterior auricular vein and common facial vein drain into internal jugular vein.Variations are not uncommon and these are more often observed in veins than in arteries. Aim of the study is to report the prevalence of unique variation of formation of external jugular vein.Head and neck of 6 cadavers (12 sides) fixed in 10% formalin were dissected in the department of anatomy AIIMS Rishikesh for the variant formation of external jugular vein.Abnormal formation of external jugular vein was detected in 1 cadaver on left side. The mean age of the cadavers was 70 years. The retromandibular vein divided into anterior and posterior divisions 2.5 cm below the angle of mandible. The facial, after travelling for 6 cm below the mandible, along with anterior and posterior divisions abnormally joined to form the external jugular vein. This is unique and rare finding.External jugular vein is used for assessment of venous pressure in right atrium and for catheterization. The variation may give false value of pressure due to facial vein draining into it, also create difficulty in catheterization. In addition to this, these veins are also used for various other procedures like carotid endarterectomy and for oral reconstruction surgeries. Thus facial vein and external jugular vein variations are of paramount importance to head and neck surgeons, anatomists and anesthetist.
Topics: Aged; Cadaver; Drainage; Face; Head; Humans; Jugular Veins; Neck; Subclavian Vein
PubMed: 32149966
DOI: 10.1097/SCS.0000000000006293 -
Physiological Reports Feb 2022Non-contact coded hemodynamic imaging (CHI) is a novel wide-field near-infrared spectroscopy system which monitors blood volume by quantifying attenuation of light...
Non-contact coded hemodynamic imaging (CHI) is a novel wide-field near-infrared spectroscopy system which monitors blood volume by quantifying attenuation of light passing through the underlying vessels. This study tested the hypothesis that CHI-based jugular venous attenuation (JVA) would be larger in men, and change in JVA would be greater in men compared to women during two fluid shift challenges. The association of JVA with ultrasound-based cross-sectional area (CSA) was also tested. Ten men and 10 women completed three levels of head-down tilt (HDT) and four levels of lower body negative pressure (LBNP). Both JVA and CSA were increased by HDT and reduced by LBNP (all p < 0.001). Main effects of sex indicated that JVA was higher in men than women during both HDT (p = 0.003) and LBNP (p = 0.011). Interaction effects of sex and condition were observed for JVA during HDT (p = 0.005) and LBNP (p < 0.001). We observed moderate repeated-measures correlations (r ) between JVA and CSA in women during HDT (r = 0.57, p = 0.011) and in both men (r = 0.74, p < 0.001) and women (r = 0.66, p < 0.001) during LBNP. While median within-person correlation coefficients indicated an even stronger association between JVA and CSA, this association became unreliable for small changes in CSA. As hypothesized, JVA was greater and changed more in men compared to women during both HDT and LBNP. CHI provides a non-contact method of tracking large changes in internal jugular vein blood volume that occur with acute fluid shifts, but data should be interpreted in a sex-dependent manner.
Topics: Adult; Female; Head-Down Tilt; Humans; Jugular Veins; Lower Body Negative Pressure; Male; Optical Imaging; Sensitivity and Specificity; Sex
PubMed: 35150210
DOI: 10.14814/phy2.15179 -
Journal of Vascular Research 2020Impaired venous reactivity has potential to contribute to clinically significant pathologies such as arteriovenous fistula (AVF) maturation failure. Vascular segments... (Comparative Study)
Comparative Study
INTRODUCTION
Impaired venous reactivity has potential to contribute to clinically significant pathologies such as arteriovenous fistula (AVF) maturation failure. Vascular segments commonly used in murine preclinical models of AVF include the carotid artery and external jugular vein. Detailed descriptions of isometric procedures to evaluate function of murine external jugular vein ex vivo have not been previously published.
OBJECTIVE
To establish isometric procedures to measure naive murine external jugular vein reactivity ex vivo.
METHODS
Vasomotor responses of external jugular veins and ipsilateral common carotid arteries from C57BL/6 mice were evaluated using isometric tension procedures.
RESULTS
External jugular veins developed tension (p < 0.05) to potassium chloride and U-46619, but not to phenylephrine, whereas common carotid arteries responded to all 3 agents (p < 0.05). While maximal responses to acetylcholine (ACh) were similar between the venous and arterial segments, the dose required to achieve this value was lower (p < 0.05) in the artery versus vein. Nitric oxide synthase inhibition attenuated (p < 0.05) but did not abolish ACh-evoked vasorelaxation in both vascular segments, whereas cyclooxygenase blockade had no effect. Endothelium-independent vasorelaxation to sodium nitroprusside was similar in the artery and vein.
CONCLUSION
Vasorelaxation and vasocontraction can be reliably assessed in the external jugular vein in C57BL/6 mice using isometric procedures.
Topics: Animals; Carotid Artery, Common; Endothelium, Vascular; Jugular Veins; Male; Mice, Inbred C57BL; Muscle, Smooth, Vascular; Myography; Nitric Oxide; Nitric Oxide Synthase Type III; Prostaglandins; Receptors, Adrenergic, alpha-1; Vasoconstriction; Vasoconstrictor Agents; Vasodilation; Vasodilator Agents
PubMed: 32541137
DOI: 10.1159/000508129 -
Phlebology Jun 2021External jugular vein (EJV) aneurysm is an extremely uncommon clinical condition. We have studied the clinical profile and need for surgery in this present seven case...
OBJECTIVE
External jugular vein (EJV) aneurysm is an extremely uncommon clinical condition. We have studied the clinical profile and need for surgery in this present seven case series of primary external jugular vein aneurysms.
METHOD
Over the past three years, we have diagnosed and managed aneurysms of external jugular vein in seven patients, who presented with swelling in the posterior triangle of the neck. Venous duplex was obtained in all the patients, followed by computed tomography (CT) in three patients and one patient reported with magnetic resonance (MR) venography from another hospital. Three patients had symptoms ranging from mild intermittent discomfort to moderate pain underwent excision of aneurysm after ligation of both ends of EJV. Four patients had swelling on the lateral side of the neck due to EJV aneurysm, with no other associated symptoms. They were kept on six monthly follow-ups.
RESULT
We operated three patients, as they were symptomatic, of which only two had thrombus in the aneurysmal sac. All three symptomatic patients had aneurysm of size >5 cm. Post-surgery and on subsequent follow-ups they were asymptomatic. The four asymptomatic patients kept on conservative management did not develop any thrombosis of aneurysm sac in follow up.
CONCLUSION
Surgical excision is indicated for symptomatic patients with EJV aneurysm, preferably for size > 5 cm because of their higher association with thrombosis or symptoms. Asymptomatic patients can be managed non-operatively with regular surveillance by clinical examination and venous duplex or can be treated if patients insist due to cosmetic reasons.
Topics: Aneurysm; Humans; Jugular Veins; Neck; Phlebography; Subclavian Vein
PubMed: 33251950
DOI: 10.1177/0268355520975583