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KMID : 1147320170040020041
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Journal of Surgical Ultrasound
2017 Volume.4 No. 2 p.41 ~ p.47
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Anatomical Variations in the Internal Jugular Vein on Ultrasound and Computed Tomography for Performing Vascular Cannulation
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Park Byung-Wook
Lee Han-Byul
Kim Hyang-Kyoung
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Abstract
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Purpose: The internal jugular vein (IJV) is known to have many anatomic variations and is associated with various complications during puncture. We tried to confirm whether the preprocedural computed tomography (CT) image could be used as a reference by replacing the real-time ultrasound (US) guidance during catheterization.
Methods: We retrospectively analyzed 250 patients who received central venous catheter (CVC) insertion through the right IJV whose US and CT images were available from September 2013 to March 2016. The relative position of the IJV to the carotid artery was categorized into five groups by the vertical axis to the ground on US and CT (CTg) or by perpendicular axis to the skin on CT (CTs). The IJVs were divided into two groups according to the degree of safety for cannulation as groups of favorable anatomy (FA) and unfavorable anatomy (UA).
Results: According to US, FA and UA, there were 91 (36.4%) and 159 (63.6%) patients, 181 (72.4%) and 69 (27.6%) patients in the CTg, 35 (14.0%) and 215 (86.0%) patients in the CTs. There was a statistically significant difference between CTg and CTs images (P＜0.001), as well as between US and CT images (P＜0.001).
Conclusion: CT images could provide limited information about anatomic variations in the IJV. However, when the neck is rotated, the degree of overlap of the IJV and carotid artery increases. Therefore, due to frequent anatomic variations of the two vessels, special regards to these variations are needed when attempting catheterization through the IJV.
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KEYWORD
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Ultrasound, Internal jugular vein, Carotid artery, Central venous catheter, Computed tomography
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