title: Central venous access via external jugular vein with CT-venography using a multidetector helical 16-section CT.
abstract: OBJECTIVE
  To determine the success rate and complications of using the external jugular vein (EJV) for central venous access with a preoperative estimate of the detailed anatomical orientation of the cervical venous plexus using computed tomography venography (CT-V).
  
  
  METHODS
  Prospective, observational human study.
  
  
  METHODS
  Surgical intensive care unit.
  
  
  METHODS
  Fifty-two patients who were undergoing EJV cannulations with CT-V using a Multidetector Helical 16-section CT (MDCT).
  
  
  METHODS
  The preoperative anatomical estimation of the cervical venous plexus was performed with CT-V using an MDCT. In particular, the angulation between the EJV and the right subclavian vein (SCV) was measured. The anatomical abnormalities and the angulation between the EJV and the anterior jugular vein (AJV), transverse cervical vein (TCV), and suprascapular vein (SSV) were estimated.
  
  
  RESULTS
  The success of CT-V was achieved in 52 of 52 patients (100%). The mean angulation between the right EJV and the right SCV was 144 ± 36 degrees in the obtuse-angle cases (88%) and 72 ± 28 degrees in the sharp-angle cases (12%). A plexus of veins under the clavicle was most commonly responsible for insertion of the central venous catheter (CVC). The EJV approach resulted in a 93% rate of successful cannulations. No complications of pneumothorax or carotid artery puncture occurred during insertion procedures.
  
  
  CONCLUSIONS
  The EJV route is associated with comparable technical success and lower major procedural complication. The EJV approach with CT-V guidance is an option as the initial method when central venous cannulation must be performed under suboptimal conditions.
authors.affiliation: 1Department of Surgery, Pippu Clinic, Pippu, Town Kamikawa-Gun , Hokkaido , Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kato
authors.forename: Masahiko
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Keita
authors.initials: K
authors.lastname: Sasahara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nagase
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Onodera
authors.forename: Minoru
authors.initials: M
authors.lastname: Matsuda
authors.forename: Mineko
authors.initials: M
authors.lastname: Higuchi
authors.forename: Miki
authors.initials: M
authors.lastname: Nakano
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kobashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Furukawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000379:methods*; D062905:Central Venous Catheters; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D061330:Multidetector Computed Tomography; D010690:Phlebography; D011446:Prospective Studies