A study of the relationship between the internal jugular vein and carotid artery assessed under direct vision and ultrasonically in surgical patients and in cadavers

Abstract

INTRODUCTION & OBJECTIVES: Use of anatomical landmarks to cannulate the internal jugular veins is fraught with danger due to variations in the relative positions of the common carotid artery (CCA) and the internal jugular vein (IJV). Objective of the study was to identify anatomical variations of the relative positions of the IJV and CCA. METHODS: This was a descriptive cross-sectional study carried out from October 2012 to July 2014 at the NCTH, Ragama. The anatomy was evaluated either ultrasonically or under direct vision. Relationship of the IJV to the CCA was recorded at three levels (sternoclavicular junction-SCJ, cricoid cartilage-CC and upper border of thyroid cartilage lamina-TCL), on the right (R) and left (L) sides. RESULTS: A total of 216 participants (60 male: 156 female; median age 48 years, range 16 to 75) consisting 192 patients (89%) and 24 cadavers (11%) were included. Patients were undergoing either neck USS at the radiology department (144, 67%), central venous catheterisation under USS guidance (22, 10%) or thyroidectomy (30, 14%). At all three levels IJV was lateral to the CCA in a majority (SCJ level: R 66.5%, L 29%; CC level: R 80%, L 85%; TCL level: R 89%, L 76%). IJV was anterior to the CCA at the SCJ level in a proportion of the sample (R 11.5%, L 22%) and antero-lateral in another proportion (R 20%, L 48%). CONCLUSION: Aberrant anatomical relations between the IJV and CCA are not uncommon. Reliance solely on a technique which assumes normal anato y can lead to damage to the CCA.