Congenital internal and external jugular venous aneurysms in a child.

A 2-year-old boy presented with varices and a neck mass. Imaging studies revealed internal jugular vein aneurysm. Gradual increasing of the mass, potential thrombus formation and cosmetical considerations were indications for surgery. At surgery aneurysms of both the external and internal jugular veins were found and resected.     

Fusiform venous aneurysm of the neck in children: A report of four cases

Four children with fusiform venous aneurysms in the neck are described. Two had aneurysms of the internal jugular vein and two had aneurysms of the superficial communicating veins. The diagnosis can be suspected when a venous hum is heard over a neck mass that expands with the Valsalva maneuver. The preoperative diagnosis is confirmed by arteriography or venography. Three of the aneurysms were removed for cosmetic reasons and one is being followed.     

Construction of experimental “giant” aneurysms

Giant aneurysms were produced in dogs by initially producing a fistula between the common carotid artery and the external jugular vein. One week later the vein was ligated above and below the fistula to create a blind aneurysmal pouch. This model has been found useful in testing experimental techniques of aneurysmal obliteration by direct injection into the sac while the lumen of the parent vessel is temporarily protected by an endovascular balloon inflated at the neck of the aneurysm.     

Case Report: Primäres venöses Aneurysma der medialen Mittelfussvene als seltene Differentialdiagnose zu Ganglien am Fuss

During the last years, the aneurysms of the superficial venous system become diagnosed more frequently because of the frequent use of vascular ultrasound. The main trunks of the great or small saphenous veins are mostly affected as a consequence of pathologic venous reflux and degenerative changes of the venous wall in patients with varicose veins. Superficial venous aneurysms of the upper extremities (cephalic and basilica veins) and neck (external jugular vein) were seen often. However, superficial venous aneurysms located on the dorsum of the foot are rare and there were only several case reports published in the literature about them. We present the case of a young woman with a primary aneurysm of the medial marginal vein of the foot.     

Prediction of a small internal jugular vein by external jugular vein diameter

The relationship between internal jugular vein diameter as measured with an ultrasound imaging machine (SiteRite, Dymax) and external jugular vein diameter was studied in 50 anaesthetised patients undergoing elective cardiac surgery. There was an inverse correlation between external jugular vein diameter and internal jugular vein diameter ( r  = −0.47, p < 0.001). All patients with an external jugular vein diameter of 7 mm or greater had an internal jugular vein diameter of less than 15 mm. No patient with an external jugular vein diameter of less than 7 mm had an internal jugular vein diameter of less than 20 mm. No other patient dimension (height, weight, body mass index, neck circumference) predicted internal jugular vein size. These results suggest that a large external jugular vein (i.e. 7 mm or greater in external diameter) may be associated with a small internal jugular vein. A size 5.0-mm internal diameter tracheal tube may be used to provide a rapid assessment of external jugular vein diameter.     

Phlebectasia of the external jugular vein with thrombosis: report of a case

An 81-year-old male presented with a soft mass on his neck noted in the supine position. After undergoing an operation for an inguinal hernia, the mass was noted to persist regardless of the patient’s position. Computed tomography and magnetic resonance imaging revealed phlebectasia of the external jugular vein with an associated thrombosis. Under general anesthesia, the external jugular vein was ligated and removed, along with the thrombus. A histological section revealed that the tunica media of the external jugular vein was absent, and the smooth muscle layer and elastic fibers were attenuated in the fusiform area of the vein. Due to the risk of propagation of the clot and pulmonary embolism, resection of the external jugular vein is advised in cases of phlebectasia of the external jugular vein.     

Current perspectives on management of congenital jugular vein aneurysms

True aneurysms of the internal jugular vein are relatively rare. This study describes 3 cases and the current management of congenital internal jugular vein aneurysms.     

Experimental arterial aneurysms: Modification of the production technique

Vein pouches obtained from the external jugular vein were used to create experimental aneurysms on the carotid arteries of 13 rabbits and the abdominal aortas of 18 rabbits. Eighteen of these vein pouch aneurysms were grafted onto a linear incision in the artery; 13 of the aneurysms were grafted onto an elliptical incision. In 4 of the rabbits in which the vein pouch was grafted onto an elliptical arteriotomy in the carotid, a new approach for producing an intracranial aneurysm was attempted by relocating the aneurysm segment to the subarachnoid space at the cranial vertex. The results indicate that the aneurysms grafted onto an elliptical arteriotomy had a higher patency rate than the aneurysms grafted onto a linear arteriotomy in both the aortic and carotid models. Also, the attempt to produce an intracranial model demonstrated that short-term patency of the aneurysms could be achieved and that a two-stage approach to creating such aneurysms would be more appropriate than a one-stage approach.     

The great veins of the neck

The great veins of the neck are of considerable importance, for example, in cannulation for a central venous line. The internal jugular vein commences as the continuation of the sigmoid sinus and emerges from the jugular foramen with the IX, X and XI cranial nerves. It terminates behind the manubriosternal joint by joining the subclavian vein to form the brachiocephalic vein. Its surface markings are the depression between the two heads of the sternocleidomastoid. In the neck the internal jugular vein lies in the carotid sheath with the carotid artery and the vagus nerve; the cervical sympathetic chain lies immediately behind. The subclavian vein commences as the continuation of the axillary vein at the lateral border of the first rib. It passes across the first rib superficial to scalenus anterior, which itself is crossed by the phrenic nerve. It receives a single tributary – the external jugular vein. The small subclavius muscle protects the subclavian artery from injury in fractures of the clavicle. The right brachiocephalic vein passes vertically downwards. Its meets the left brachiocephalic vein behind the lateral border of the manubrium to form the superior vena cava, which passes downwards to enter the right atrium.     

Neck haematoma and airway obstruction in a patient with goitre: complication of internal jugular vein cannulation

Attempted jugular vein cannulation in a patient with a discrete goitre resulted in a rapid growing haematoma and airway obstruction. This life-threatening complication is rare, and is usually related to two conditions: pre-existing coagulopathy and/or arterial puncture by a large bore cannula or vessel dilator. None of these was present in this patient. Investigations revealed a retrosternal goitre causing tracheal compression and major changes in the calibre and the anatomical relationships of neck vessels. Possible origin and mechanism for the sudden haematoma are discussed, as well as the airway management. This case clearly illustrates how internal jugular vein cannulation using the traditional blind technique, guided by external landmarks, can be extremely hazardous in patients with distorted anatomy of the neck.     

Subclavian venous aneurysm: case report and review of the literature

A case of a symptomatic 5.1-cm left subclavian venous aneurysm, which was treated with surgical excision, is presented. Most venous aneurysms in the head and neck region involve the internal or external jugular veins and are asymptomatic. Aneurysms involving the subclavian or axillary veins are rare. The natural history of these aneurysms is benign with no reported instances of rupture or thromboembolic events. Operative treatment is most often undertaken for cosmetic reasons or for the development of symptoms.     

Percutaneous insertion of CSF ventriculoatrial shunts — a new technique

Summary In conventional techniques concerning insertion of ventriculoatrial shunt systems, the route to the caval system is accomplished by a lateral rightsided neck dissection and isolation usually of the facial or the external jugular vein, in order to introduce the atrial catheter into the internal jugular vein and consequently the superior vena cava.A new approach for catheterization of the internal jugular vein is proposed. The technique is a combination of the well proven approach for percutaneous catheterization of the vein and a technique used in the implantation of permanent pacemaker leads.We find the method suitable for cases whenever a VA-shunt is prefered.     

An anatomical study on the availability of contralateral recipient vessels in hemi-mandibular reconstruction with vascularised free fibula transfer

Background: In mandibular reconstruction with vascularised free fibula transfer, there are situations where the neck on the operated site lacks recipient vessels for vascular anastomosis due to previous radiological/surgical interventions.

Methods: The present study aims to clarify the availability of neck vessels on the contralateral side in such situations. Experimental surgery was conducted on 20 fresh cadavers (six males and 14 females). After the left half of the mandible was removed, free vascularised fibula of equivalent length was transferred to fill the defect. The possibility of connecting the peroneal artery and vein to the superior thyroid artery (STA), transverse coli artery (TCA), internal jugular vein (IJV), and external jugular vein (EJV) of the contralateral side was evaluated.

Results: In all samples, the peroneal vessels could reach the STA and EJV. However, the peroneal vessels could reach the TCA and IJV of the contralateral side in only 45% and 64.2% of cases, respectively. The average and standard deviation of the lengths by which vessels were insufficient were 1.1?±?13.9?mm for IJV and 8.8?±?24.7?mm for TCA.

Conclusions: In reference to these findings, it is concluded that, in situations where neck vessels of the defect side are unavailable, availability of the superior thyroid artery and external jugular vein should be examined first. When these vessels are available as recipient vessels, direct vascular anastomosis is highly likely to be successful. In cases where these vessels are unavailable and the transverse coli artery or internal jugular vein is used as the recipient, vascular interposition might be necessary.     

Internal jugular vein occlusion in head and neck microsurgical reconstruction

The internal jugular vein has been the preferred recipient vein in head and neck microsurgical reconstruction. However, recent reports have demonstrated internal jugular vein occlusion after functional neck dissection. The purpose of this article is to demonstrate and discuss the possibility of recipient internal jugular vein occlusion after free tissue transfer. Of 58 patients who received an end-to-side venous anastomosis with the internal jugular vein, four cases of recipient internal jugular vein occlusion were detected during the early postoperative period. Although the success rate of end-to-side anastomosis with the internal jugular vein may be high, microsurgeons should be aware of the possibility of internal jugular vein occlusion.     

An algorithm for recipient vessel selection in microsurgical head and neck reconstruction

This article details an algorithm we used for selection of recipient vessels in free tissue transfer to the head and neck. Eighty-eight consecutive free flaps to the head and neck were performed in 85 patients. The superior thyroid was the commonest recipient artery used (61%). The facial artery, used in 14% of our cases, is the choice vessel in instances where neck dissection is not performed. In these cases, we have to access the neck separately for recipient vessels and it can be exposed easily via a short (3-cm) incision. The superficial temporal artery (11%) is our choice vessel for patients with previous neck dissection or radiotherapy as it is well outside the previous operative or irradiated field. Other vessels such as the transverse cervical and end-to-side anastomosis to the carotid artery were also used when appropriate. Recipient vein selection depends primarily on the selected artery. Corresponding veins and large branches of the internal jugular vein (IJV) in the vicinity of the selected artery are preferred. When these are exhausted, the external jugular vein and end-to-side anastomosis to the IJV are considered. We found this algorithm to be reliable in identifying the appropriate vessels in all cases.     

Experiences with Swan-Ganz-catheter placement in the external jugular vein

Clinical experience concerning the placement of Swan-Ganz catheters (SGC) via the external jugular vein is presented. After puncture of either the right or left external jugular vein, placement of SGC was possible in 90 per cent of patients. Compared to techniques involving puncture of the internal jugular vein this method has less complications. The placement of 167 SGC could be done without any problems, thus proving that the external jugular vein is a safe way of insertion. The external jugular vein as a primary route can be recommended if the vein is visible, especially in cases where puncture of the internal jugular vein may be difficult and could only be performed with an increased risk of complications.     

Peritoneal shunt migration into the pulmonary artery--case report

A 48-year-old man underwent ventriculoperitoneal shunting for hydrocephalus secondary to subarachnoid hemorrhage due to left vertebral artery dissection, which had been successfully treated by trapping. The peritoneal catheter was correctly positioned via a right upper abdominal incision, and symptoms related to the hydrocephalus disappeared. One month later, the patient began to complain of pain on the right side of the neck. Chest radiography revealed that the peritoneal end of the catheter had migrated into the right pulmonary artery. The catheter route was explored through a small neck incision, and was found to enter the external jugular vein. The catheter was extracted and repositioned into the peritoneum. This type of shunt migration is quite unusual, but could be lethal by causing pulmonary infarction or arrhythmia. The catheter had probably entered the external jugular vein through a perforation caused by the shunt guide during the ventriculoperitoneal shunt operation. Follow-up radiography should be scheduled to detect such a complication.     

External carotid ligature: posterior approach (behind the sternocleidomastoid muscle)

Because of difficulties encountered in the ligation of the external carotid artery, both anteriorly and retrovascularly (internal jugular vein), we propose a posterior approach based on anatomic principles. This approach to the external carotid artery is especially useful when structural alterations of the anterolateral neck are present. Surgical details are presented in three patients and the results demonstrate its practicability.     

Case report: central venous catheterization via internal jugular vein with associated formation of perioperative venous thrombosis during surgery in the prone position

An unusual case of central venous catheter (CVC)-related thrombosis during supine surgery in the prone position is presented. A 76-year-old woman was scheduled for elective surgery to repair a broken lumbar instrument. A single-lumen CVC was inserted via the right internal jugular vein. Surgery was performed in the prone position, with the patient's face directed downward in the standard median position (i.e., no rotation), but with slight forward flexion at the neck. After the surgery, the external jugular vein was dilated, and a postoperative X-ray revealed an infiltrative shadow in the right thoracic cavity. Because cervical echography showed dilated cervical veins with a "moyamoya-type" echo, possibly indicating a thrombus, contrast-enhanced computed tomography was performed, revealing a venous thrombus in the right internal jugular vein. An internal jugular venous-velocity measurement suggested that her slightly flexed neck position and her prone position during surgery may have kinked the internal jugular vein, causing engorgement with venous blood. The presence of the internal jugular venous catheter may have created thrombogenic conditions. A patient's position during surgery can reduce deep venous-flow velocity, and venous blood may stagnate, contributing greatly to thrombogenicity. We should consider a patient's position during surgery as a risk factor for thrombus formation, and a careful preoperative evaluation should be made as to which route should be chosen for CVC.     

Is catheter rupture rare after totally implantable access port implantation via the right internal jugular vein? Report of a case

Catheter rupture after totally implantable access port (TIAP) implantation via the right internal jugular vein is thought to be very rare. We report a case of catheter rupture found 682 days after TIAP surgery in a 52-year-old woman with recurrent right breast cancer. It is possible that chronic stress at the flexure of the catheter induced by neck movements caused the catheter to rupture. Therefore, when inserting a TIAP via the right internal jugular vein, the site of venous puncture should be decided on carefully. Although a fracture of this type is rarely reported in the literature, the incidence of catheter injury of a TIAP inserted via the internal jugular vein at our institute is 1.8 %. This highlights the need to educate and caution medical staff and patients about preventing catheter fracture being caused by external factors.