Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-20T17:39:11.100Z Has data issue: false hasContentIssue false

Anatomical variation of left internal jugular vein: clinical significance for an anaesthesiologist

Published online by Cambridge University Press:  01 April 2008

I. Asouhidou*
Affiliation:
Aristotle University of Thessaloniki, Department of Anatomy, Medical School, Thessaloniki, Greece Aristotle University of Thessaloniki, G. Papanikolaou Hospital Exohi, Department of Cardioanaesthesiology, Thessaloniki, Greece
K. Natsis
Affiliation:
Aristotle University of Thessaloniki, Department of Anatomy, Medical School, Thessaloniki, Greece
T. Asteri
Affiliation:
Aristotle University of Thessaloniki, G. Papanikolaou Hospital Exohi, Department of Cardioanaesthesiology, Thessaloniki, Greece
P. Sountoulides
Affiliation:
Aristotle University of Thessaloniki, Department of Anatomy, Medical School, Thessaloniki, Greece
K. Vlasis
Affiliation:
Aristotle University of Thessaloniki, Department of Anatomy, Medical School, Thessaloniki, Greece
P. Tsikaras
Affiliation:
Aristotle University of Thessaloniki, Department of Anatomy, Medical School, Thessaloniki, Greece
*
Correspondence to: Irene Asouhidou, Department of Cardioanaesthesiology, G. Papanikolaou Hospital Exohi, 15-17 Agiou Evgeniou street, Kalamaria 55133, Thessaloniki, Greece. E-mail: [email protected]; Tel: +30 23104 52560; Fax: +30 23102 50608
Get access

Summary

Background and objectives

Cannulation of a central vein is an everyday procedure in anaesthesiology. However, anatomical variations of the size and/or location of the internal jugular vein might prevent cannulation, while repeated efforts might lead to severe complications. The aim of this retrospective study was to explore anatomical abnormalities of the internal jugular vein with regard to diameter of the vein’s lumen and to define their clinical significance.

Methods

The cervical regions of 93 cadavers, 186 sides in total, were dissected and the anatomical variations of internal jugular vein diameters in relation to the external jugular vein and to the common carotid artery were recorded and photographed.

Results

The diameter of the veins in three cases were less than 6 mm, while ipsilateral external jugular veins were larger than average (3/93).

Conclusions

Anatomical variations of the internal jugular veins are clinically significant, especially in cases where venous access is important.

Type
Original Article
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Coté, CJ, Jobes, DR, Schwartz, AJ, Ellison, N. Two approaches to cannulation of a child’s internal jugular vein. Anesthesiology 1979; 50: 371373.CrossRefGoogle ScholarPubMed
2.Macdonald, S, Watt, AJB, McNally, D, Edwards, RD, Moss, JG. Comparison of technical success and outcome of tunneled catheters inserted via the jugular and subclavian approaches. J Vasc Intervent Radiol 2000; 11: 225231.CrossRefGoogle ScholarPubMed
3.Bambauer, R, Inniger, R, Pirrung, KJ, Pirrung, KJ, Schiel, R, Dahlem, R. Complications and side effects associated with large-bore catheters in the subclavian and internal jugular veins. Artif Organs 1994; 18: 318321.CrossRefGoogle ScholarPubMed
4.Cimochowski, GE, Worley, E, Rutherford, WE, Sartain, J, Blondin, J, Harter, H. Superiority of the internal jugular over the subclavian vein access for temporary dialysis. Nephron 1990; 54: 154161.CrossRefGoogle ScholarPubMed
5.Schillinger, F, Schillinger, D, Montagnac, R, Milcent, T. Post catheterization vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant 1991; 6: 722724.CrossRefGoogle ScholarPubMed
6.Bernard, RW, Stahl, WM. Subclavian vein catheterizations: a prospective study. I. Non-infectious complications. Ann Surg 1971; 173: 184190.CrossRefGoogle ScholarPubMed
7.Mansfield, PF, Hohn, DC, Fornage, BD, Gregurich, MA, Ota, DM. Complications and failures of subclavian-vein catheterization. N Engl J Med 1994; 331: 17451748.CrossRefGoogle ScholarPubMed
8.Sznajder, JI, Zveibil, FR, Bitterman, H, Weiner, P, Bursztein, S. Central vein catheterization: failure and complication rates by three percutaneous approaches. Arch Intern Med 1986; 146: 259261.Google Scholar
9.Asteri, T, Tsagaropoulou, I, Vasiliadis, K, Fessatidis, I, Papavasiliou, E, Spyrou, P. Beware Swan-Ganz complications. Perioperative management. J Cardiovasc Surg 2002; 43: 467470.Google ScholarPubMed
10.Gamulin, Z, Bruckner, JC, Forster, A, Simonet, F, Rouge, JC. Multiple complications after internal jugular vein catheterisation. Anaesthesia 1986; 41 (4): 408412.CrossRefGoogle ScholarPubMed
11.Butsch, JL, Butsch, WL, Da Rosa, JF. Bilateral vocal cord paralysis. A complication of percutaneous cannulation of the internal jugular veins. Arch Surg 1976; 111 (7): 828.CrossRefGoogle ScholarPubMed
12.Kua, JS, Tan, IK. Airway obstruction following internal jugular vein cannulation. Anaesthesia 1997; 52 (8): 776780.CrossRefGoogle ScholarPubMed
13.Nazarian, GK, Foshagei, MC. Color Doppler sonography of the thoracic inlet veins. Radiographics 1995; 15 (6): 13571371.CrossRefGoogle ScholarPubMed
14.English, IC, Frew, RM, Pigott, JF, Zaki, M. Percutaneous catheterisation of the internal jugular vein. Anaesthesia 1969; 24 (4): 521531.CrossRefGoogle ScholarPubMed
15.National Kidney Foundation. K/DOQI clinical practice guidelines for vascular access. Am J Kidney Dis 2001; 37: S137S181.Google Scholar
16.Koja, H, Tokumine, J, Sugahara, K, Yamashiro, S, Uezu, T, Koja, K. Subcutaneous pulsating neck mass after left internal jugular venipuncture. J Cardiothorac Vasc Anesth 2006; 20 (2): 290.Google Scholar
17.Oguzkurta, L, Tercana, F, Karaa, G et al. US-guided placement of temporary internal jugular vein catheters: immediate technical success and complications in normal and high-risk patients. Eur J Radiol 2005; 55: 125129.CrossRefGoogle Scholar
18.Turba, UC, Uflacker, R, Hannegan, C, Selby, JB. Anatomic relationship of the internal jugular vein and the common carotid artery applied to percutaneous transjugular procedures. Cardiovasc Intervent Radiol 2005; 28: 303306.CrossRefGoogle ScholarPubMed
19.Riopelle, JM, Ruiz, DP, Hunt, JP et al. Circumferential adjustment of ultrasound probe position to determine the optimal approach to the internal jugular vein: a noninvasive geometric study in adults. Anesth Analg 2005; 100: 512519.CrossRefGoogle Scholar
20.Troianos, CA, Kuwik, RJ, Pasqual, JR, Lim, AJ, Odasso, DP. Internal jugular vein and carotid artery anatomic relation as determined by ultrasonography. Anesthesiology 1996; 85 (1): 4348.CrossRefGoogle ScholarPubMed
21.Lin, BS, Kong, CW, Tarng, DC, Huang, TP, Tang, GJ. Anatomical variation of the internal jugular vein and its impact on temporary haemodialysis vascular access: an ultrasonographic survey in uraemic patients. Nephrol Dial Transplant 1998; 13: 134138.CrossRefGoogle ScholarPubMed
22.Nayak, BS. Surgically important variations of the jugular veins. Clin Anat 2006; 19 (6): 544546.CrossRefGoogle ScholarPubMed
23.Gordon, AC, Saliken, JC, Johns, D, Owen, R, Gray, RR. US-guided puncture of the internal jugular vein: complications and anatomic considerations. J Vasc Interv Radiol 1998; 9: 333338.CrossRefGoogle ScholarPubMed
24.Williams, PT, Bannister, LH, Berry, MM et al. Gray’s Anatomy. New York: Churrchill Livingstone, 2004.Google Scholar
25.Downie, SA, Schalop, L, Mazurek, JN, Savitch, G, Lelonek, GJ, Olson, TR. Bilateral duplicated internal jugular veins: case study and literature review. Clin Anat 2007; 20 (3): 260266.CrossRefGoogle ScholarPubMed
26.Alderson, PJ, Burrows, FA, Stemp, LI, Holtby, HM. Use of ultrasound to evaluate internal jugular vein anatomy and to facilitate central venous cannulation in paediatric patients. Br J Anaesth 1993; 70: 145148.Google Scholar
27.Nakayama, S, Yamashita, M, Osaka, Y. Right internal jugular vein venography in infants and children. Anesth Analg 2001; 93 (2): 331334.CrossRefGoogle ScholarPubMed
28.Denda, S, Mochida, T, Taneoka, M, Honda, H, Kitahara, Y, Nishimaki, H. Internal jugular vein cannulation guided by ultrasonography in pediatric patients undergoing cardiovascular surgery. Masui 2007; 56 (1): 6973.Google ScholarPubMed
29.Denys, BG, Uretsky, BF. Anatomical variations of internal jugular vein location: impact on central venous access. Crit Care Med 1991; 19 (12): 15161519.CrossRefGoogle ScholarPubMed
30.Taal, MW, Chesterton, LJ, McIntyre, CW. Venography at insertion of tunnelled internal jugular vein dialysis catheters reveals significant occult stenosis. Nephrol Dial Transplant 2004; 19: 15421545.CrossRefGoogle ScholarPubMed
31.Mey, U, Glasmacher, A, Hahn, C et al. Evaluation of ultrasound-guided technique for central venous access via the internal jugular vein in 493 patients. Support Care Cancer 2003; 11: 148155.Google Scholar
32.Lim, CL, Keshava, SN, Lea, M. Anatomical variations of the internal jugular veins and their relationship to the carotid arteries: a CT evaluation. Australas Radiol 2006; 50 (4): 314318.CrossRefGoogle Scholar
33.Armstrong, PJ, Sutherland, R, Scott, DH. The effect of position and different manoeuvres on internal jugular vein diameter size. Acta Anaesthesiol Scand 1994; 38 (3): 229231.CrossRefGoogle ScholarPubMed
34.Yildirim, I, Yuksel, M, Okur, N, Okur, E, Kylic, MA. The sizes of internal jugular veins in Turkish children aged between 7 and 12 years. Int J Pediatr Otorhinolaryngol 2004; 68 (8): 10591062.Google Scholar
35.Skolnick, ML. The role of sonography in the placement and management of jugular and subclavian central venous catheters. AJR 1994; 163: 291295.CrossRefGoogle ScholarPubMed
36.Conz, PA, Dissegna, D, Rodighiero, MP, La Greca, G. Cannulation of the internal jugular vein: comparison of the classic Seldinger technique and an ultrasound guided method. J Nephrol 1997: 311313.Google Scholar