title: The internal jugular vein maintains its regional anatomy and patency after carotid endarterectomy: a prospective study.
abstract: OBJECTIVE
  To validate the authors' published surface landmarks for gaining percutaneous access to the internal jugular vein (IJV), and to determine whether these surface landmarks were altered after neck surgery.
  
  
  BACKGROUND
  Carotid puncture and pneumothorax continue to be the most frequent mechanical complications of percutaneous IJV venipuncture, particularly when the anterior or posterior approaches are used. The authors' modified technique of IJV venipuncture was associated with a 0.6% complication rate; notably, there were no instances of carotid artery puncture. Determining the accuracy of this method using duplex ultrasound would enhance the technique's applicability and safety. The authors also hypothesized that previous neck surgery would alter the regional anatomy in relation to these surface landmarks for IJV venipuncture.
  
  
  METHODS
  The authors prospectively evaluated 417 IJVs in 209 consecutive patients undergoing carotid duplex imaging before and after carotid endarterectomy (CEA). Patients who had undergone CEA were enrolled to investigate the effect of neck surgery on IJV anatomy. The opposite, nonoperated side of the neck served as a control for each patient. The position of the IJV in relation 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 evaluated.
  
  
  RESULTS
  Overall accuracy of the surface landmarks for locating the IJV percutaneously was 99% for the control group and 95% for the CEA group. With neck 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 jugular vein in 85% of the patients in both groups. The mean size of the vein and 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. IJV anatomy is not altered after CEA.
authors.affiliation: Department of Surgery at University of California-Davis, Sacramento, California, USA. vijay.khatri@ucdmc.ucdavis.edu
authors.forename: V P
authors.initials: VP
authors.lastname: Khatri
authors.forename: S
authors.initials: S
authors.lastname: Wagner-Sevy
authors.forename: M H
authors.initials: MH
authors.lastname: Espinosa
authors.forename: J B
authors.initials: JB
authors.lastname: Fisher
mesh_terms: D000368:Aged; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D018616:Ultrasonography, Doppler, Duplex