Patency Of Internal Jugular Vein Research Articles

Assessment of Patency of Internal Jugular Vein in Carcinoma Oral Cavity Patients Undergoing Neck Dissection: A Prospective Observational Study

ABSTRACT Background: Neck dissections in carcinoma oral cavity are associated with various postoperative comorbidities. Internal jugular vein (IJV) occlusion and stenosis is a rare serious complication, which leads to serious clinical sequalae. Existing medical literature reports an incidence of this complication varying from 0% to 30%. Lacunae exist regarding any correlation between clinicopathological parameters and treatment options, of such patients, with the incidence of this complication, which might aid in adapting a preventive approach accordingly. Aims and Objectives: a. Primary objective: To study the patency of IJV postoperatively with preoperative status b. Secondary objective: Correlation of postoperative IJV patency with clinicopathological parameters (age, subsite, and pathological nodal status) and treatment options offered (neck dissection, radiotherapy, and reconstruction). Subject and Methods: Patency of IJV was analyzed preoperatively and postoperatively and correlated with various parameters, after neck dissection in 50 carcinoma oral cavity patients. Settings and Design: Prospective observational study at a tertiary care hospital done over 2 years. Statistical Analysis Used: Data were recorded in Excel data sheet and statistically analyzed by using the SPSS Ver 22.0. Results: IJV occlusion was demonstrated in 2 (4%) patients and IJV stenosis in 7 (14%) patients. Postradiotherapy patients had higher incidence of occlusion compared to patients who did not undergo radiotherapy (11.7% vs. 0%; P < 0.05). The incidence of stenosis and occlusion was significantly higher in left side neck dissection (20.6%; P < 0.05). Conclusion: Radiotherapy and left sided neck dissection are statistically significant risk factors for postoperative IJV occlusion in carcinoma oral cavity patients.

Nerve and vein preserving neck dissections for oral cancers: a prospective evaluation of spinal accessory nerve function and internal jugular vein patency following treatment.

Nerve and vein preserving modification of the radical neck dissection is commonly used in the management of oral squamous cell cancers. There is limited literature addressing nerve function and vein patency following treatment. We prospectively analysed 65 patients with nerve conduction study using surface electromyography at baseline, 1 month and 6 months post-surgery and colour Doppler of the internal jugular vein at baseline and 1 month post-surgery. We also studied functional outcomes of nerve sparing with arm abduction test and Neck Dissection Quality of Life questionnaire. There was a statistically significant increase in mean latency of motor action potential and decrease in the mean amplitude of the motor action potential following surgery, suggesting nerve dysfunction. Following surgery, there was a significant decrease in the diameter of the vein as well as an increase in the velocity of blood flow; there was partial thrombus in 5% of individuals. In conclusion, even though nerve dysfunction compromised shoulder abduction, vein dysfunction rarely resulted in any significant clinical impact.

Obstruction of Venous Drainage Linked to Transient Global Amnesia.

Abnormal extracranial venous drainage modality has been considered an etiology of transient global amnesia (TGA). Evidence suggests that the transmission of the intrathoracic/intraabdominal pressure during a Valsalva maneuver (VM) is mainly through the vertebral venous system, and patency of internal jugular vein (IJV) is essential for venous drainage and pressure releasing. We hypothesize that obstruction of IJV venous drainage is a contributing factor in TGA pathogenesis. A magnetic resonance (MR) imaging protocol was used in 45 TGA patients and 45 age- and sex-matched controls to assess the morphologies of IJV, brachiocephalic vein (BCV) and asymmetry of transverse sinus (TS). The IJV was divided into the upper- and middle-IJV segments. Compared to the controls, TGA patients had significantly higher rates of moderate and severe compression/stenosis at the bilateral upper-IJV segment (left: 37.8% vs. 17.8%, P = 0.0393; right: 57.8% vs.15.6%, P<0.0012), in left BCV (60% vs. 8.9%, P<0.0004), and in TS hypoplasia (53.3%% vs. 31.1%, P = 0.0405). The prevalence of at least one site of venous compression/stenosis in IJV or BCV was significantly higher in patients than in controls (91.1% vs. 33.3%, P<0.0004). The diameter of the left TS in MRV, but not in T1 contrast imaging, was significantly smaller in TGA patients than in controls (0.31±0.21 vs. 0.41±0.19, P = 0.0290), which was compatible with downstream venous stenosis/obstruction. TGA patients have a higher prevalence of compression/stenosis of the bilateral IJV and the left BCV and TS hypoplasia, which is new evidence that supports the role of extracranial veins in TGA pathogenesis.

Factors influencing internal jugular vein patency after neck dissection in oral cancer

The objective was to investigate factors influencing internal jugular vein stenosis or occlusion after neck dissection, including the reconstructive procedure. The subjects were 73 patients (81 veins) who underwent a modified radical neck dissection, in which the internal jugular vein was preserved, or an extended supraomohyoid neck dissection (E-SOHND). All procedures were performed by the same surgeon. Internal jugular vein patency was evaluated by contrast-enhanced computed tomography. Patency was evaluated in relation to gender, side of dissection, number of pathological lymph node metastases, extracapsular spread of lymph node metastases, radiotherapy, and the reconstruction method (no reconstruction, free flap, or pedicle flap). All internal jugular vein occlusions were on the left side and all except one of these patients underwent radiotherapy. Thus, radiotherapy and left side dissection were significant risk factors for occlusion. Free flap reconstruction was not a risk factor for vein stenosis or occlusion. Patients undergoing reconstruction with pedicled musculocutaneous flaps or E-SOHND were less likely to have vein occlusion. Particular care is required for left neck dissection in patients who have undergone radical neck dissection on the right side. This study suggests that covering the internal jugular vein with the muscle might prevent vein occlusion.

Internal Jugular Vein Patency and Methods of Reconstruction after Neck Dissection in Patients with Oral Cancer:

Internal Jugular Vein Patency and Methods of Reconstruction after Neck Dissection in Patients with Oral Cancer:

口腔癌頸部郭清術後における内頸静脈開存状態と治療内容に関する検討

根治的頸部郭清術変法や選択的頸部郭清術において，術後保存した内頸静脈に狭窄や閉塞が生じることが報告されている。本稿の目的は，頸部郭清術後の内頸静脈狭窄や閉塞に影響する因子を再建法も含めて検討することである。当院において同一術者が施行した内頸静脈を温存した根治的頸部郭清術変法または拡大肩甲舌骨筋上頸部郭清術の51例58側を対象とした。性別，郭清側，pN個数，被膜外浸潤の有無，放射線照射の有無および再建法と内頸静脈開存状態との関連について造影CTを用いて検討を行った。閉塞例は全例，左側で放射線照射症例であり，放射線照射は有意な危険因子であった。遊離皮弁再建は狭窄または閉塞の危険因子ではなかった。大胸筋皮弁再建症例もしくは拡大肩甲舌骨筋上頸部郭清術症例では有意に閉塞が少なく，内頸静脈を筋体で被覆することが閉塞予防になる可能性が示唆された。

口腔癌頸部郭清術後の内頸静脈開存状態の検討

口腔癌頸部郭清術後の内頸静脈開存状態の検討

Patency of Internal Jugular Vein Following Repair after ECMO Stabilization Prior to Berlin Heart Implantation: Utility of Repaired Vein for Subsequent Cardiac Catheterization and Biopsy

The objective of this study was to examine the patency and utility for subsequent vascular access of the internal jugular vein following use in short-term extracorporeal membrane oxygenation. Retrospective review. Pediatric cardiac intensive care unit, pediatric cardiac catheterization laboratory, and pediatric cardiac clinic. Four children, ages 7-178 months, requiring mechanical circulatory support. Interventions. Extracorporeal membrane oxygenation support, internal jugular vein repair, Berlin Heart mechanical circulatory support, heart transplantation, cardiac catheterization. Following surgical repair, the internal jugular vein was studied with bedside ultrasound for assessment of patency. When appropriate, subsequent vascular access of the vessel was attempted and the success was reported. Follow-up ultrasound examination demonstrated vessel patency in all cases. In patients requiring subsequent catheterization (3/4), successful vessel entry and catheterization were performed. Repair of the internal jugular vein following use for short-term extracorporeal membrane oxygenation support can be accomplished with success. The vessel can be used for subsequent vascular access when necessary.

Valsalva manoeuvre for central venous cannulation

We report a case of a difficulty inserting a Hickman line that was overcome by asking the patient to perform a Valsalva manoeuvre. A middle-aged woman of short stature weighing 72 kg and BMI 33, required a line for long-term chemotherapy. A left-sided approach was chosen due to previous surgery on her right breast and axilla. We planned to insert a Bard single lumen 6.6 Fr Hickman line (Bard Access Systems, Crawley, UK) into the left axillary or subclavian vein. Ultrasound detected a small deep axillary vein and the subclavian vein was therefore selected. Cannulation was guided by fluoroscopy. The vein was punctured above the first rib using a micropuncture technique and the wire passed readily into the brachiocephalic vein. When the wire was advanced further it repeatedly passed into the ipsilateral internal jugular or the contralateral subclavian vein. Elevating or depressing the shoulders and turning the head made no difference to the course of the wire. Finally, we asked the patient to take a deep breath, hold her nose with her fingers, close her mouth and breath out maximally (like straining when passing stool), after which the wire passed immediately into the superior vena cava. In our experience of inserting over 1000 subclavian and axillary vein Hickman lines we have often encountered difficulty in directing the wire in to the superior vena cava. Indeed, 7% of jugular lines are reported to be misplaced in the axillary vein [1] and 5% of subclavian lines are incorrectly positioned in the ipsilateral jugular vein [2]. Howes and Dell recently reported a difficult central venous line insertion using the right subclavian approach [3] when the guide wire repeatedly passed in to the right jugular vein despite using ultrasound guidance and the superior vena cava could not be cannulated. If this occurs we advise removing the wire and injecting contrast to ensure that the vein is not thrombosed proximally. This is particularly important in patients who have had previous central line catheters as there is a 13% risk of thrombosis after long-term subclavian vein catheters and a 3% risk after internal jugular vein catheters [4]. Repositioning of the patient as described above can often facilitate wire placement but on occasions we have found the Valsalva manoeuvre to be successful. The application of 20 cmH2O of continuous positive airway pressure has been shown to maintain internal jugular vein patency and reduce the incidence of kinking and locking of the guide wire [5]. Asking the patient to take a deep breath may also straighten the great vessels and help wire positioning [6]. Alternatively, specialised directional wires or blockers can be used but are generally reserved for use by a skilled radiologist.

Evidence of Significant Sternocleidomastoid Atrophy following Modified Radical Neck Dissection Type III

Although modified radical neck dissection type III preserves the spinal accessory nerve, the internal jugular vein, and the sternocleidomastoid muscle, the authors believe there is a significant morbidity to retained structures after neck dissection. Although the effects on accessory nerve function and internal jugular vein patency have been documented, there is little information about sternocleidomastoid morphology and function following modified dissection. Using a SonoSite ultrasound machine, the authors assessed sternocleidomastoid muscle morphology, at rest and during contraction, in a cohort of 45 patients who underwent modified radical neck dissection type III with no radiotherapy. All patients had head and neck cancers and received unilateral neck dissection as part of their primary treatment. Static and dynamic measurements were performed at three different levels of the muscle, with the neck in the neutral position. The contralateral neck of the same patient was used as a control. Local muscle asymmetry patterns were calculated using the Absolute Asymmetry Index. Significant sternocleidomastoid atrophy was noted on the side of modified radical neck dissection type III (p < 0.05). The atrophy was particularly marked in the caudal and middle portions of the sternocleidomastoid muscle and was likely related to damage to the segmental blood supply in the caudal and middle portions of the muscle as well as injury to the innervation. Despite evidence of significant atrophy, the muscle still underwent morphological changes during contraction that were comparable to those on the normal control side.

PD.203 Internal jugular vein patency after free flap reconstruction of the maxillofacial region. Ultrasonographic results in 42 patients

PD.203 Internal jugular vein patency after free flap reconstruction of the maxillofacial region. Ultrasonographic results in 42 patients

Assessment of patency of the internal jugular vein following neck dissection and microvascular flap reconstruction by power Doppler ultrasound.

The objective of this study was to assess patency of the internal jugular vein following modified radical or selective neck dissection and microvascular flap reconstruction by power Doppler ultrasound and its impact on free flap survival. In 23 patients who underwent selective or modified radical neck dissection and microvascular flap reconstruction the patency of the internal jugular vein was examined by power Doppler ultrasound on the first post-operative day and after follow-up of at least four months. On the first post-operative day in one patient partial thrombosis was found, while in the other 22 patients the internal jugular vein was normal patent. During follow-up in 17 (74 per cent) patients a normal patent internal jugular vein was found, while partial and complete thrombosis were found in three (13 per cent) patients each. On the first post-operative day 22 of the 23 (96 per cent) free flap veins were visualized. There was no free flap loss during follow-up. Power Doppler ultrasound is a valuable diagnostic technique for determination of internal jugular vein patency and may be useful as screening method or in case of clinical suspicion of thrombosis to determine internal jugular vein patency. Late internal jugular vein thrombosis may probably not effect free flap survival due to neovascularization.

Internal jugular vein patency after lateral neck dissection: a prospective study.

In spite of anatomical preservation of the internal jugular vein (IJV), an occlusion rate of the vessel of up to 30% has been documented after selective or modified radical neck dissections. The aim of the present prospective study was to evaluate the patency of the IJV following selective lateral neck dissection (LND) in 34 patients affected by squamous cell carcinoma of the upper aerodigestive tract who underwent surgery concomitantly on the primary site and the neck. Eighteen patients received unilateral and 16 bilateral LND, for a total of 50 IJVs. Postoperative radiotherapy on the neck was delivered in four patients with histologic evidence of micro-extracapsular spread; the impact of this variable on IJV patency was assessed by the Fisher test. A preoperative baseline study of vein patency and flow by ultrasonography (US) was obtained. Postoperative controls were scheduled at 1 week, 1 month and 3 months following surgery. No patient developed either wound infection or a pharyngocutaneous fistula, and no signs or symptoms of IJV occlusion were observed during the postoperative course. At the first US control, 25 IJVs (50%) did not present any alteration in patency, and 23 (46%) and 2 (4%) had a reduced or absent flow, respectively. At the second and third controls, 33 (66%) and 45 (90%) of the IJVs presented with normal flow, respectively. At the end of the study, none of the patients showed evidence of occlusion. Postoperative radiotherapy did not have a statistically significant impact on IJV patency ( P=0.09). In conclusion, long-term IJV occlusion after LND has to be considered an exceedingly rare event with negligible morbidity. However, alterations of IJV flow frequently occur in the immediate postoperative course.

Internal jugular vein patency following carotid endarterectomy.

We performed ultrasound examinations on forty-five patients with a history of carotid endarterectomy to assess the patency and position of the internal jugular vein on the side of the endarterectomy. The study was performed in a tertiary referral centre. In the 55 internal jugular veins examined (ten bilateral procedures), the veins were patent and in a normal relationship to the carotid artery. We concluded that previous carotid surgery should not be a contraindication to cannulation of the internal jugular vein.

Internal jugular vein patency in patients undergoing microvascular reconstruction.

The objective of this study was to determine the incidence of internal jugular vein thrombosis in patients undergoing free flap reconstruction and simultaneous neck dissection. Patients underwent Doppler ultrasound examination of their internal jugular veins on postoperative days 1 and 7 after functional neck dissection and free flap transfer. Long-term follow up was obtained at a minimum of 3 months. The incidence of internal jugular vein thrombosis in patients undergoing free flap reconstruction with simultaneous neck dissection is similar to that of patients undergoing just neck dissection. A significant number of these veins recanalize and have excellent long term patency. There does not seem to be a correlation between venous thrombosis and free flap survival.

Internal jugular vein patency following functional neck dissection

Internal jugular vein patency following functional neck dissection

Internal jugular vein patency after functional neck dissection: venous duplex imaging.

We present a retrospective study performed to determine jugular patency after functional neck dissection (FND). Twenty-six patients, 16 females and 10 males, ranging in age from 16 to 78 were examined. These patients underwent either unilateral FND or bilateral FND for cervical lymph node metastases. Cervical duplex and pulsed Doppler imaging were chosen to determine internal jugular vein (IJV) patency. The examination was performed after a minimum postoperative period of 2 months and a maximum one of 22 years. Thirty-one IJVs were examined. All but 4 IJVs examined were found patent postoperatively. The preservation rate of patency of the IJV in FND was found to be high (27 of 31 or 87%). These results favor the use of FND for IJV preservation, particularly in bilateral neck dissection.