The internal jugular vein maintains its regional anatomy and patency aftercarotid endarterectomy: A prospective study

Objective To validate the authors' published surface landmarks for gaining percutaneous access to the internal jugular vein (IJV), and to determine wh ether these surface landmarks were altered after neck surgery. Summary Background Data Carotid puncture and pneumothorax continue to be th e most frequent mechanical complications of percutaneous IJV venipuncture, particularly when the anterior or posterior approaches are used. The author s' modified technique of IJV venipuncture was associated with a 0.6% compli cation rate; notably, there were no instances of carotid artery puncture. D etermining the accuracy of this method using duplex ultrasound would enhanc e the technique's applicability and safety. The authors also hypothesized t hat previous neck surgery would alter the regional anatomy in relation to t hese surface landmarks for IJV venipuncture. Methods The authors prospectively evaluated 417 IJVs in 209 consecutive pat ients undergoing carotid duplex imaging before and after carotid endarterec tomy (CEA). Patients who had undergone CEA were enrolled to investigate the effect of neck surgery on IJV anatomy. The opposite, nonoperated side of t he neck served as a control for each patient. The position of the IJV in re lation 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 e valuated. Results Overall accuracy of the surface landmarks for locating the IJV perc utaneously was 99% for the control group and 95% for the CEA group. With ne ck 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 jugul ar vein in 85% of the patients in both groups. The mean size of the vein an d its patency were similar in both groups. Conclusions Duplex imaging validated the accuracy of the surface landmarks for IJV cannulation and documented the adverse effects of neck rotation. IJ V anatomy is not altered after CEA.