Bilateral Internal Jugular Vein Research Articles

Internal Jugular Vein Velocity and Spontaneous Echo Contrast Correlate with Alzheimer's Disease and Cognitive Function.

Many issues persist in the today's Alzheimer's disease (AD) screening and the breakthrough method is desired. We aim to validate the association between venous reflux and AD, and to develop a new method for AD screening. We examined spontaneous echo contrast, area, diameter, retrograde velocity, and anterograde velocity of the bilateral cervical internal jugular vein (IJV) using carotid ultrasonography. A total of 112 patients participated in this study, with 26 diagnosed as AD. The proportion of both or either IJV spontaneous echo contrast (+) occupied 25 of total 26 AD patients, which showed 96.2%of sensitivity and 98.5%negative predictive value. The IJV velocities also showed significant correlation with AD diagnosis, although the IJV area or diameter did not. Our results indicate that the validation of the spontaneous echo contrast or velocities of the IJV are convenient AD diagnosis screening methods and that the venous reflux disturbance correlates with AD development.

A Novel Use of Suction Thrombectomy for Embolic Protection During Mechanical Ileocaval Thrombectomy

We have reported on a novel use of the AngioVac suction thrombectomy device (AngioDynamics, Latham, NY) for vacuum-assisted embolic protection in a case of extensive mechanical thrombectomy of a caval–visceral deep vein thrombosis (DVT) that was refractory to standard catheter-directed thrombolysis. To the best of our knowledge, this is the first report of the use of a vacuum-assisted suction thrombectomy device for successful embolic protection. A 15-year-old girl had developed extensive, symptomatic bilateral ileocaval and renal vein DVTs refractory to outpatient management with anticoagulation therapy after pharmacomechanical thrombectomy and catheter-directed lysis. Initially, she had been treated successfully with overnight lytic therapy for the ileocaval DVT, and she was discharged with anticoagulation therapy. However, she had presented again with worsening bilateral lower extremity symptoms and kidney injury due to progression of the DVT. To prevent end-organ failure, extensive endovascular mechanical thrombectomy was planned. With the patient's significant thrombus burden through the visceral and retrohepatic inferior vena cava (IVC), pulmonary embolic protection during mechanical thrombectomy was our chief concern. Given the extent of the clot, IVC filter placement was impossible. Therefore, an AngioVac suction thrombectomy cannula and circuit was established via bilateral internal jugular vein access in an attempt to debulk the thrombus from a superior approach and provide pulmonary embolic protection. Mechanical thrombectomy (ClotTriever; Inari Medical, Irvine, Calif) was used to successfully debulk the IVC and bilateral ileofemoral venous segments from the bilateral popliteal veins. Although the use of the AngioVac from above proved unable to debulk the thrombus, it was successful in preventing significant embolism during ClotTriever mechanical thrombectomy (Fig 1). After mechanical thrombectomy (Fig 2), the patient's creatinine had returned to normal. She continued anticoagulation therapy, with Doppler ultrasound imaging showing reduction of the DVT and improvement of her lower extremity symptoms. We believe the present case has illustrated successful pulmonary embolic protection using a large-bore suction thrombectomy device with venoveno bypass during endovascular mechanical thrombectomy of caval, visceral, and bilateral ileofemoral DVTs. The AngioVac cannula and circuit can be safely and effectively used for central embolic protection in the case of large-volume caval mechanical thrombectomy.Fig 2Doppler ultrasound image showing reduction of the deep vein thrombosis (DVT) after mechanical thrombectomy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Role of Non Invasive Diagnosis of Internal Jugular Vein Phlebectasia.

Phlebectasia is the abnormal saccular fusiform dilatation (without tortuosity) of a vein, which may affect any vein. Its etiology remains unknown and it is seen usually in the pediatric age group as a unilateral lower neck swelling, mostly on the right side. The other differential diagnoses of the neck swellings which increase in size during a Valsalva manoeuver are tumors or cysts of the upper mediastinum, external laryngeal diverticulum or laryngoceles. Our case report has highlighted the importance of understanding the nature of this lesion by using non-invasive radiological diagnostic modalities (USG), in order to avoid invasive investigations which can lead to catastrophic results. Case report. We describe a case of five year old boy with history of inguinal hernia repair a year ago presented with intermittent right sided neck swelling since he was two years old. His examination at rest was normal. However, with the Valsalva manoeuver a soft, painless, compressible swelling which appeared in the right lower neck was seen, which was not attached to the deep structures. Flexible nasopharyngolaryngoscope revealed normal laryngeal finding. Initial ultrasound finding revealed normal looking cervical lymph nodes bilaterally with no suspicious cystic lesion or collection. Patient then arranged for MRI neck where there are multiple bilateral subcentimeter cervical lymph nodes. However, repeated ultrasound neck while performing Valsalva manoeuver by patient showed sonographic features in keeping with bilateral internal jugular veins phlebectasia. Patient then was referred to pediatric surgeon for further management. A clinical diagnosis can be achieved by having a strong suspicion about this intermittent neck mass. It should be evaluated with non-invasive radiological modalities to avoid the possible catastrophic results which result from invasive techniques.

Associations Between Doppler Internal Jugular Vein Blood Flow and Transverse Sinus Stasis Detected by Magnetic Resonance Imaging.

This study aimed to compare the estimated internal jugular vein (IJV) volume flow with Doppler ultrasound in patients with slow flow in the transverse sinuses and normal transverse sinuses on brain magnetic resonance imaging (MRI). Eighty patients between the ages of 18 and 80 years who did not have any signs of sinus vein thrombosis on brain MRI were included. On MRI, cases with hyperintensity due to a signal void loss in the transverse sinuses in coronal fluid attenuation inversion recovery sequences were included in the slow-flow group. The presence of sinus thrombosis was excluded with other MRI pulse sequences and clinical findings. The participants were divided into 2 groups as having normal and slow flow according to MRI findings. Then bilateral IJV volume flow measurements were made by Doppler ultrasound. Bilateral volume flow was estimated by time-averaged blood flow velocities sampled in the center of the IJV, and IJV cross-sectional areas were measured. We defined the dominant IJV as the one having the higher estimated volume flow of the 2 sides. Total estimated IJV blood flow was lower (P < .001) in patients with slow flow on MRI (546 mL/min) compared to those without (768 mL/min). A similar finding was seen for the nondominant IJV. In a receiver operating characteristic analysis, the cutoff value for the total estimated IJV volume flow was determined to be 590 mL/min, and the cutoff value for nondominant estimated IJV volume flow was determined to be 202 mL/min to distinguish between the groups. Low estimated volume blood flow in the IJV is associated with MRI evidence of stasis in the ipsilateral transverse sinus.

Application of thromboelastography combined with point-of-care ultrasound to prevent internal jugular vein catheterization related thrombosis

To investigate the effect of thromboelastography (TEG) combined with point-of-care ultrasound (POCUS) guidance on the prevention of internal jugular vein catheterization related thrombosis. The patients who required internal jugular vein catheterization admitted to the department of critical medicine of Beihai People's Hospital from December 2018 to April 2020 were enrolled. Patients were divided into two groups according to the random number table method. For the combined cathetherization group, ultrasound was used to examine bilateral internal jugular veins before catheterization. The larger diameter and better filled vein and site were selected for puncture. If both internal jugular veins were not fulfilled well, puncture were performed after fluid administration. At the same time, anticoagulant, antiplatelet or reducing blood viscosity drugs were used according to coagulation function and bleeding risk under the monitoring of TEG. The hemodynamic state of the internal jugular vein was monitored by ultrasound every day. If the vein collapsed or the blood flow was slow, the cause should be tried to be found and improved. Once thrombosis was found, the catheter should be removed. For the routine cathetherization group, the right side internal jugular vein was prior to be punctured according to body surface symbols. The other treatment of the two groups were the same as routine treatment. The conditions of thrombosis and bleeding were recorded. Ninety-seven patients were selected, 51 cases in the combined cathetherization group and 46 cases in the routine cathetherization group. There was no significant differences in gender, age, acute physiology and chronic health evaluation II (APACHE II), risk of deep vein thrombosis score (Caprini), CRUSADE bleeding risk score, the proportion of high bleeding risk, disease types, the proportion of coagulation disorder and catheterization time between the two groups, but the anticoagulation treatment proportion in the combined cathetherization group was higher than that in the routine cathetherization group (66.7% vs. 30.4%, P < 0.01). The incidence of thrombosis in the combined cathetherization group was lower than that of the routine cathetherization group (39.2% vs. 78.3%, P < 0.01), and the thrombus of the combined cathetherization group was smaller than that of the routine cathetherization group [cm3: 0.077 (0.047, 0.089) vs. 0.341 (0.070, 0.378), P < 0.01]. There were no major bleeding events in the two groups. Based on TEG and POCUS, the antithrombotic bundles can reduce the incidence of thrombosis after internal jugular vein catheterization and the thrombus size, and does not increase the risk of bleeding, which is worthy of clinical application.

Head of bed elevation in pediatric patients with severe traumatic brain injury.

Head of bed (HOB) elevation to 30° after severe traumatic brain injury (TBI) has become standard positioning across all age groups. This maneuver is thought to minimize the risk of elevated ICP in the hopes of decreasing cerebral blood and fluid volume and increasing cerebral venous outflow with improvement in jugular venous drainage. However, HOB elevation is based on adult population data due to a current paucity of pediatric TBI studies regarding HOB management. In this prospective study of pediatric patients with severe TBI, the authors investigated the role of different head positions on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebral venous outflow through the internal jugular veins (IJVs) on postinjury days 2 and 3 because these time periods are considered the peak risk for intracranial hypertension. Patients younger than 18 years with a Glasgow Coma Scale score ≤ 8 after severe TBI were prospectively recruited at a single quaternary pediatric intensive care unit. All patients had an ICP monitor placed, and no other neurosurgical procedure was performed. On the 2nd and 3rd days postinjury, the degree of HOB elevation was varied between 0° (head-flat or horizontal), 10°, 20°, 30°, 40°, and 50° while ICP, CPP, and bilateral IJV blood flows were recorded. Eighteen pediatric patients with severe TBI were analyzed. On each postinjury day, 13 of the 18 patients had at least 1 optimal HOB position (the position that simultaneously demonstrated the lowest ICP and the highest CPP). Six patients on each postinjury day had 30° as the optimal HOB position, with only 2 being the same patient on both postinjury days. On postinjury day 2, 3 patients had more than 1 optimal HOB position, while 5 patients did not have an optimal position. On postinjury day 3, 2 patients had more than 1 optimal HOB position while 5 patients did not have an optimal position. Interestingly, 0° (head-flat or horizontal) was the optimal HOB position in 2 patients on postinjury day 2 and 3 patients on postinjury day 3. The optimal HOB position demonstrated lower right IJV blood flow than a nonoptimal position on both postinjury days 2 (p = 0.0023) and 3 (p = 0.0033). There was no significant difference between optimal and nonoptimal HOB positions in the left IJV blood flow. In pediatric patients with severe TBI, the authors demonstrated that the optimal HOB position (which decreases ICP and improves CPP) is not always at 30°. Instead, the optimal HOB should be individualized for each pediatric TBI patient on a daily basis.

Cerebral Venous Infarction due to Internal Jugular Vein Thrombosis: A Case Study and Review of Literature

Cerebral venous sinus thrombosis (CVST) is an uncommon disease entity. In contrast-enhanced computed tomography (CT) or magnetic resonance venography (MRV) images of the brain, CVST usually manifests as a filling defect of the dural venous sinuses. Brain parenchymal involvement in CVST can be ranged from parenchymal oedema to haemorrhagic infarctions. Though the most frequent cause of haemorrhagic infarction in brain is CVST, other rare causes such as cerebral venous outflow obstruction due to neck vein pathology have been reported. We report a rare case of haemorrhagic brain infarctions secondary to bilateral internal jugular vein thrombosis in a 17-year-old woman, who has presented with worsening headache and seizures. She had high susceptibility of getting venous thrombosis for being a young female on oral contraceptive pills. While reporting a rare cause of cerebral haemorrhagic infarctions, this case report highlights the need for having a high degree of suspicion to diagnose CVST. Further, this case report emphasises the value of prompt and adequate imaging of neck veins if the haemorrhagic infarction presents with patent cerebral venous sinuses.

Idiopathic Bilateral Internal Jugular Vein Thrombosis Diagnosed by Point-of-Care Ultrasound.

Internal jugular vein (IJV) thrombosis is an unusual condition, especially when it develops bilaterally. This is a case of bilateral IJV thrombosis in a 77-year old female who presented to the emergency department with neck and arm swelling after discontinuing apixaban and undergoing an oropharyngeal procedure. The diagnosis of bilateral IJV thrombosis was made with the use of point-of-care ultrasound to evaluate bilateral jugular vein distention and bilateral upper extremity pitting edema found on her physical examination.

Analysis of a First Unilateral and Then Bilateral Internal Jugular Vein Thrombosis in a Heroin User

This report documents a first unilateral and then bilateral internal jugular vein (IJV) thrombosis as a result of repeated injections of heroin, which is rare in a practice of oral and maxillofacial surgeon. The patient was a 21-year-old male who was referred to a hospital with the diagnosis of phlegmon of the right neck. Emergency non-contrast computed tomography (5 images and 1 Supplemental Video are presented) revealed a hyperattenuating content in the lumen of expanded right IJV which fills its entire length. The patient received initial treatment according to the protocol. Ultrasound (US) (2 images and 2 Supplemental Videos are presented) in a first 24 hours supported the diagnosis describing a case as occlusive acute thrombosis. After 4 days of a positive dynamic the patient was transferred to outpatient mode. In a 10 day US examination (2 images and 2 Supplemental Videos are presented) simultaneously with positive changes in the lumen of a right IJV (partial clot lysis) an appearance of a left IJV thrombosis was noted. Analysis of thrombotic conditions of the neck, diagnostics methods, treatment options, and complications are performed.

Treatment of superior vena cava syndrome using AngioJet\u2122 thrombectomy system

BackgroundSuperior vena cava syndrome is a relatively rare presentation in which diminished venous return to the heart produces congestion of the neck, face and upper extremities. Typically, a mediastinal mass produces external compression on the superior vena cava and reduces venous return. However, superior vena cava syndrome can present acutely in the setting of vena cava thrombosis. Multiple scoring systems are available to assist clinicians with appropriate timing of interventions for SVC syndrome. When specific criteria are met, endovascular intervention can be beneficial to patients to prevent rapid deterioration.Case presentationA 75-year-old female with no significant past medical history presented to the emergency department with increased facial swelling, nausea and vomiting which began the night prior to presentation. The patient underwent a CT chest which revealed a 3.2 × 3.0 × 3.8 cm spiculated mass compressing the right main bronchus and right pulmonary artery. The patient was intubated and interventional radiology was consulted. The patient underwent venography which showed extensive thrombosis of the innominate veins. Rheolytic thrombectomy with AngioJet™ was performed to alleviate clot burden and minimize risk of secondary pulmonary embolism. Kissing stents were placed in the bilateral innominate veins to maintain patency after thrombectomy. After the procedure, the patient was successfully extubated and had near complete resolution of facial swelling approximately 12 h post procedure. A follow up venogram performed on post procedure day 4 showed patent bilateral subclavian, innominate, and internal jugular veins as well as a patent superior vena cava.ConclusionsAcute occlusion of superior vena cava can present with life threatening symptoms such as loss of airway. AngioJet™ thrombectomy is another tool available to interventional radiologists when a patient’s clinical condition necessitates treatment.

The inside-out technique for tunneled dialysis catheter placement with central venous occlusion

The “inside-out” technique eliminates the need for subclavian or femoral catheter placement by placing a supraclavicular catheter via a percutaneous femoral vein access. Few reports of its use in vascular surgery exist. The purpose of this article is to describe our version of the technique and report results. Between 2016 and 2017, the inside-out technique was performed on eight patients. All patients had more than four prior access sites and bilateral internal jugular vein occlusion. The technical success rates were 100% with no periprocedural complications and success in achieving dialysis access. One patient required catheter replacement within 48 hours, one catheter was used as a bridge to Hemodialysis Reliable Outflow (Hemosphere, a Cryolife Inc Company, Eden Prairie, Minn) graft placement, and one patient died of sepsis unrelated to their catheter. Our data show the inside-out technique to be safe and effective, removes the need for subclavian or femoral catheter placement, and should be a component of treatment algorithms for complex dialysis patients, which is consistent with National Kidney Foundation's Kidney Disease Outcomes Quality Initiative recommendations.

Reduced Left Jugular Venous Remodeling and Graft Patency in a Preclinical Model

Venous remodeling, the adaptive structural and functional reorganization of the venous wall after intervention, is still not well understood. Up to 60% of arteriovenous fistulas fail to mature adequately to sustain hemodialysis as the vein fails to adequately thicken and dilate in response to arterial flow. To examine venous remodeling, we used a pig arteriovenous graft (AVG) model to expose veins to arterial flow without changing their geometry. Because humans have smaller diameter and cross-sectional area of the left internal jugular vein (IJV) compared with the right IJV, we hypothesized that left-sided AVGs may have different remodeling and patency compared with right-sided AVGs in a preclinical model. Ten Yorkshire male pigs (mean weight, 48 kg; age, 3.4 months) underwent ipsilateral or bilateral placement of AVGs from the proximal common carotid artery to the distal IJV using polytetrafluoroethylene (6 mm in diameter, 6-7 cm in length). Pigs were observed for 1 week, 2 weeks, or 3 weeks. Select pigs underwent ultrasound measurements of flow and ultrasound and caliper measurements of vessel diameters before graft placement. Vessels were harvested from two additional pigs that had undergone procedures unrelated to the IJV for control measurements. Grafts and vessels were excised and analyzed with histologic evaluation. At baseline, there was no significant difference in peak systolic or end-diastolic velocities between the left and right IJVs. The left and right IJVs also did not demonstrate any difference in caliper-measured diameters or ultrasound-measured luminal diameters. Histologic analysis of preoperative bilateral IJVs showed no difference in wall thickness or intima-media surface area. There were 10 left-sided and 8 right-sided polytetrafluoroethylene grafts placed; 4 of 10 (40%) were patent on the left and 7 of 8 (88%) were patent on the right (P = .03996, χ2 test). Postoperatively, the right IJV showed an increase in wall thickness (0.15 to 0.35 mm; P < .0001) and intima-media surface area (0.17 to 0.35 mm2; P = .0024) compared with baseline, but significant thickening was not seen on the left side. Left-sided grafts had increased luminal macrophages at the arterial anastomosis compared with right-sided grafts, but there was no significant difference in macrophage number at the venous anastomosis. Left-sided jugular veins do not thicken to the degree that right-sided veins thicken on exposure to the AVG environment. Lack of left jugular venous remodeling was associated with reduced graft patency in this preclinical model. These data suggest anatomic differences in different venous beds, emphasizing the need to understand the biology of venous remodeling to optimize graft patency.

Transient Global Amnesia Linked to Impairment of Brain Venous Drainage: An Ultrasound Investigation.

Background: Previous neuroimaging and ultrasound studies suggested that compression and stenosis of the internal jugular vein (IJV) in patients with transient global amnesia (TGA) may impair IJV drainage, while a patent IJV releases intracranial pressure caused by the Valsalva maneuver (VM).Methods: Seventy-nine TGA patients with complete ultrasound examination data during admission were recruited prospectively to evaluate IJV drainage, which included the time-averaged mean velocity, and the cross-sectional lumen area of the IJV at the vein's middle (J2) and distal (J3) segments and the cross-sectional area during a 10-s VM to test for any retrograde or anti-grade flow. Forty-five TGA patients and 45 age- and sex-matched control subjects underwent complete contrast-enhanced magnetic resonance (MR) venous studies, which included time-resolved imaging of contrast kinetics, contrast-enhanced axial T1-weighted MR imaging, and phase-contrast-based non-contrast enhanced magnetic resonance venography (MRV).Results: In those subjects with complete MRV studies, the flow volumes exhibited at both the J2 and J3 segments of the left IJV and left vertebral vein (VV) were significantly lower in the TGA patients than in the control subjects. Although there was no significant difference in the flow volume of right IJV, the total of bilateral IJV, and VV flow volumes was still significantly lower in the TGA patients. As compared with the control subjects, the TGA patients exhibited significantly higher prevalence of completely blocked right IJV drainage at the J3 segment during the VM, but non-significantly higher for the left IJV at the J3 segment and for the right IJV at the J2 segment.Conclusion: Our results confirmed that the total venous flow decreases in the IJVs and VVs of the patients with TGA. This is consistent with the findings of previous MR imaging studies that have reported about compression and stenosis of the draining veins. We also found that IJV drainage is relatively compromised during the VM in the patients with TGA.

Color Doppler Ultrasound Evaluation of Internal Jugular Vein Before Radical Neck Dissection

Objective: There is a great controversy about whether the internal jugular vein (IJV) should be retained during radical neck dissection. In this study, the right and left IJV under different body position were observed by color Doppler ultrasound, in order to provide a experimental basis for the preservation of IJV in neck dissections. Methods: A total of 40 patients with thyroid cancer undergoing radical neck dissection were examined in this study. The hemodynamic data such as section area, velocity, and volume of blood flow were measured by Doppler in supine and sitting position under quiet breath. Results: In supine position, the cross sectional area, the velocity and the blood flow volume in the right side were 58%, 23% and 91% more than left side respectively. The right side advantage, symmetrical, and left side advantage of IJV was in 65%, 25%, and 10% of patients. The blood flow of bilateral IJV was 74% of total cerebral outflow. The IJV predominate, balanced type, and no-IJV predominate cerebral venous drainage was in 73%, 23% and 5% of patients. In sitting position, the section area, the velocity and the blood flow volume in the right side were 29%, 35% and 56% more than left side respectively. The right side advantage, symmetrical, and left side advantage of IJV was in 45%, 45%, and 10% of patients. The blood flow of bilateral IJV was 23% of total cerebral outflow. The balanced type and no-IJV predominate cerebral venous drainage was in 23% and 78% of patients. Conclusions: There are side advantage of IJV. With quiet breathing, IJV is not the main pathway of cerebral venous drainage in sitting position. The preoperative ultrasound is useful to design the individualized surgical approach for the radical neck dissections.

Evaluation of the structure and hemodynamics of internal jugular veins by ultrasound in normal population

Objective To investigate the structure and hemodyanmics characteristics of internal jugular veins (IJV) in normal population. Methods A total of 126 individuals for stroke screening and IJV ultrasound examination from Oct 2017 to May 2018 in our hospital were enrolled.The the level of IJV influx into innominate vein (J1), the level of superior thyroid vein influx into IJV (J2) and the level of the segment equal to from the bifurcation of common carotid artery to out of skull(J3) of IJV were evaluated by ultrasound. The parameters included the maximum diameters of the three segments during the smooth respiration period, cross section area (CSA), the maximum velocity (Vmax), mean flow volume (FVm) and the maximum pressure gradient (PGmax). The parameters of bilateral IJVs were compared. The effects of gender and age on these parameters were analyzed. Results The structures and hemodynamics parameters of left IJV were lower than those of right IJV (all P 0.05). With aging, the left/right ratio of Vmax and PGmax were decreased, especially at J1 segment (P<0.05). Conclusions Color Doppler flow imaging can evaluate the IJV structures and hemodynamics by assessing the diameter, CSA, Vmax, FVm and PGmax. Right IJV is the dominated outflow side in normal population. With aging, the drainage of left IJV is decreased. Key words: Ultrasonography; Jugular vein; Hemodynamics; Structure; Normal population

Studying alternative approaches for placement of cuffed hemodialysis catheters in hemodialysis patients with bilateral internal jugular vein occlusion.

Internal jugular vein occlusion often makes necessary the use of less desirable routes as external jugular, subclavian, and femoral vein approaches in addition to inferior vena cava approaches. This a prospective cross-sectional follow-up study of the alternative approaches for placement of cuffed hemodialysis catheters in end-stage renal disease patients with bilateral internal jugular vein occlusion from the interventional nephrology point of view. The study was conducted on 134 end-stage renal disease patients who were referred for insertion of a challenging hemodialysis catheter due to bilateral internal jugular vein occlusion. Ultrasound Doppler guided catheter insertion was used as a routine practice in addition to fluoroscopy or post insertion X-ray to localize catheter tip position and exclude complications. Follow-up of patients was conducted until the end of the study or catheter removal. The most highly prevalent alternative approach is the trans-external iliac vein inferior vena cava approach (43.28%) followed by external jugular vein approach (14.93%), innominate vein approach (10.18%), internal jugular vein collaterals by interventional radiology (7.46%), femoral vein approach (7.46%), transhepatic approach (5.97%), subclavian vein approach (5.22%), and finally the retrograde femoral vein approach (1.49%). End-stage renal disease patients maintained on regular hemodialysis who have bilateral internal jugular vein obstruction and non-functioning arteriovenous fistula/graft is a daily scenario in nephrology practice. Our study showed that there is a variety of approaches for the insertion of cuffed hemodialysis catheters other than occluded internal jugular veins. Interventional nephrologists have a major role in solving the problem of poor hemodialysis vascular access. These alternative approaches can conserve the anatomically limited number of percutaneous access sites in each patient.

Assessment of Hemodynamic Alterations in Cerebral Veins in Patients With Intracerebral Hemorrhage Using Duplex Color-Coded Sonography.

To investigate the contributions of hemodynamic alterations in cerebral veins to the prognosis of patients with primary intracerebral hemorrhage (ICH). Duplex color-coded sonography was performed on 87 ICH patients between July 2016 and October 2017. The time-averaged peak velocity, the time-averaged mean velocity (TAMV), the blood flow volume (BFV) of bilateral internal jugular veins (IJVs) and vertebral veins (VVs), and the mean velocities of bilateral basal veins of Rosenthal, straight sinus, and bilateral transverse sinuses were calculated to understand the relationship of hemodynamic data with prognosis in patients with ICH. The study revealed that the time-averaged peak velocities, TAMVs and BFVs of both right IJV and VV in ICH patients with good clinical outcomes were higher than those of the left IJV and VV, whereas statistically significant differences were not found in the mean velocity of bilateral veins of Rosenthal. The perihematomal edema volume, time-averaged peak velocities, TAMVs, and BFVs of the bilateral IJVs and right VV and the TAMV of the left VV were associated with the prognosis of ICH patients in the univariate analysis. However, the TAMV of the right IJV and BFV of the left IJV were the independent factors that predicted prognosis in multivariate analysis. Partial correlation showed that there was a linear dependence between the differences in TAMV and BFV between bilateral IJVs. The presence of hemodynamic changes in cerebral veins in patients with ICH has an impact on prognosis.

Bilateral internal jugular vein thrombosis due to malignant tumor

BackgroundThe aim of the study was to analyze characteristics of patients with bilateral internal jugular vein thrombosis in our department during a 1-year period.Internal jugular vein thrombosis refers to an intraluminal thrombus occurring anywhere from the intracranial internal jugular vein to the junction of the internal jugular vein and the subclavian vein, which form the brachiocephalic vein. It can occur spontaneously or as a complication of head and neck infections, surgery, central venous lines, local malignancy, polycytemia, hyperhomocysteinemia, neck massage, or intravenous drug abuse. Spontaneous bilateral internal jugular vein thrombosis may occur as a result of a neoplasm, a condition called Trousseau’s syndrome.MethodsThe medical records of four patients with internal jugular vein thrombosis were reviewed for patient clinical characteristics, including age, sex, and other diseases. This is a retrospective study, and we analyzed four patients who had distant malignant tumors.ResultsDuring a 1-year period, four male patients were referred to our department for bilateral internal jugular vein thrombosis. Three of them had lung neoplasm, and one had urinary tract neoplasm. Three patients had thrombosis in the upper arm at the same time, one of them in both arms. Therapy consisted of unfractioned heparin in all patients. The main clinical manifestations were pain and cervical edema. The time between the first clinical manifestation and diagnosis of internal jugular vein thrombosis was 4 days. In the current study, no patient exhibited complications due to internal jugular vein thrombosis.ConclusionsDiagnosing internal jugular vein thrombosis requires a high degree of suspicion. Our study underlines that bilateral internal jugular vein thrombosis is a risk indicator for malignancy. In our literature review of internal jugular vein thrombosis, 85% of patients exhibited unilateral thrombosis, whereas the remaining patients had bilateral thrombosis (15%). The knowledge of predictive factors of internal jugular vein thrombosis seems to be of utmost importance to improve patient management.

Cost-effectiveness analysis in papillary thyroid carcinoma patients with different neck dissection strategy: A retrospective cohort study

BackgroundThere are two surgical strategies for bilateral neck dissection (BND), simultaneous and two-stage operations. The aim of the study was to compare the cost-effectiveness BND with this two operations in papillary thyroid carcinoma (PTC) patients. Materials and methodsConsecutive PTC patients undergoing BND were studied retrospectively, and were classified into simultaneous group (Group A) and two-stage group (Group B). Demographic, medical costs, complication and surgical variables were recorded. ResultsThis study included 256 PTC patients, of which 175 (68.4%) underwent simultaneous BND and 81 (31.6%) patients underwent two-stage. Patients in Group B spent almost twice as much on medical costs as patients in Group A ($4145.3 vs. $7352.5). Group A patients also had shorter hospital stays (11.71 ± 5.12 vs. 23.10 ± 7.11, P < .0001) and surgery times (203.61 ± 61.43min vs. 279.58 ± 71.59min, P < .0001). The average radioactive iodine therapy delay was 67 days in Group B. There was no significant difference in complications (34 vs. 18, P = .605) or disease-free-survival (93.71% vs. 90.12%, P = .243) between the two groups. No difference was found in rates of recurrent laryngeal nerve invasion/resection (12 vs. 11, P = .08; 10 vs. 6, P = .353) or tracheotomy (32 vs. 14, P = .846). However, internal jugular vein invasions were more common in patients with two-stage BND (7 vs. 9, P = .029). ConclusionSimultaneous BND is the most cost-effective strategy for the management of PTC patients without bilateral internal jugular veins invasion, due to lower treatment cost and the ability to avoid RAI delay.

Effect of Internal Jugular Vein Compression on Intracranial Hemorrhage in a Porcine Controlled Cortical Impact Model.

Internal jugular vein (IJV) compression has been shown to reduce axonal injury in pre-clinical traumatic brain injury (TBI) models and clinical concussion studies. However, this novel approach to prophylactically mitigating TBI through venous congestion raises concerns of increasing the propensity for hemorrhage and hemorrhagic propagation. This study aims to test the safety of IJV compression in a large animal controlled cortical impact (CCI) injury model and the resultant effects on hemorrhage. Twelve swine were randomized to placement of a bilateral IJV compression collar (CCI+collar) or control/no collar (CCI) prior to CCI injury. A histological grading of the extent of hemorrhage, both subarachnoid (SAH) and intraparenchymal (IPH), was conducted in a blinded manner by two neuropathologists. Other various measures of TBI histology were also analyzed including: β-amyloid precursor protein (β-APP) expression, presence of degenerating neurons, extent of cerebral edema, and inflammatory infiltrates. Euthanized 5 h after injury, the CCI+collar animals exhibited a significant reduction in total SAH (p = 0.024-0.026) and IPH scores (p = 0.03-0.05) compared with the CCI animals. There was no statistically significant difference in scoring for the other markers of TBI (β-APP, neuronal degeneration, cerebral edema, or inflammatory infiltration). In conclusion, IJV compression was shown to reduce hemorrhage (SAH and IPH) in the porcine CCI model when applied prior to injury. These results suggest the role of IJV compression for mitigation of not only axonal, but also hemorrhagic injury following TBI.