To improve the mechanical function of bovine jugular vein by external stent

Objective To increase the mechanic characteristic of bovine jugular veins conduit (BJVC) by combined knitted stent outside made of nylon fiber. Methods Got rid of the cells of BJVC by enzymolysis,then combined a fabric stent with a acellular bovine jugular vein

Seeing beneath the surface:Harnessing point-of-care ultrasound for internal jugular vein evaluation

Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.

Modeling Blood Flow in Veins of Uniform Properties (Giraffe Jugular Vein)

This paper models the giraffe’s jugular veins as a uniform collapsible tube from a rigid skull. The equations governing one-dimensional steady flow through such a tube for various conditions have been developed. The effects of inertial and inclination angles that have not been discussed previously have been included. It has been shown that different flows for a uniform tube (vein) are possible. However, this flow matches that of a jugular vein which is supercritical, and the steady solution has been given by the balance between the driving forces of gravity and the viscous resistance to the flow at the right atrium of the heart must be sub-critical for a fixed right-atrium pressure which means that an elastic jump is required to return the flow to sub-critical from the supercritical flow upstream this type of relationship gives rise to flow limitation at the same time given any right atrium fixed pressure there exists a maximum flow rate which when exceeded the boundary conditions of the flow do not hold boundary conditions at the right atrium are not satisfied hence making the steady flow impossible this mechanism of flow limitation is slightly different from the other one in that causes airways through forced expiration from the observation made it is clearly shown that there is an intravascular pressure difference with a change in height.

Application of the “Three Threes” Method in Clinical Teaching of Internal Jugular Vein Puncture

Objective: To clarify the role of the “Three Threes” method in clinical teaching of internal jugular vein puncture and explore improvements in teaching methods. Methods: A doctor was assigned to the induction room of the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) for two months. The time required for catheterization, the first puncture success rate, and occurrence of puncture-related complications were compared before and after learning the “Three Threes” method. Results: Using the “Three Threes” method reduced the catheterization time by 43%, increased the first puncture success rate by 17%, and led to fewer puncture-related complications. Conclusion: The application of the “Three Threes” method not only improves the success rate of internal jugular vein puncture but also reduces complications, making it easier for students to master the technique.

Malignant meningioma with jugular vein invasion and carotid artery extension:A case report and review of the literature

BACKGROUND Grade II and III meningiomas[World Health Organization(WHO)classification]rarely have extracranial metastases via the blood circulation;however,we experienced a case with a metaplastic atypical meningioma and local dedifferentiation that metastasized to the jugular vein,carotid artery and subclavian artery at the cervicothoracic junction.Such cases have seldom been reported before.CASE SUMMARY The patient was a 30-year-old man who developed right neck masses with dysphagia,labored breathing,dizziness,and occasional earaches.Eight months earlier the patient was diagnosed with a right parietal lobe neoplasm and hemorrhage at a local hospital due to the sudden onset of headaches and left limb weakness,and the post-operative pathology was a metaplastic atypical meningioma(WHO grade II)with local de-differentiation(WHO III).Magnetic resonance imaging revealed a calcified mass at the root of the neck on the right and a large cystic mass in the right parapharyngeal space.Head and neck angiography showed that the right common carotid artery was compressed and completely occluded,and the jugular vein was enveloped by the tumor and occluded.A balloon occlusion test showed no perfusion in the right common carotid artery.Tumor resection,carotid artery ligation,and subclavian artery reconstruction were performed.The tumor was a malignant meningioma.Postoperatively,the patient had Horner's syndrome and hoarseness.CONCLUSION This case highlights the importance of the link between a large cervical mass and a primary intracranial tumor.Malignant meningioma should not be considered merely as an intracranial metastasis spread through cerebrospinal fluid,it can also be transferred through the circulation to the parapharyngeal space and the cervical great vessels.

Thoracic duct cannulation during left internal jugular vein cannulation:A case report

BACKGROUND Central venous catheter insertion is an invasive procedure that can cause complications such as infection,embolization due to air or blood clots,pneumothorax,hemothorax,and,rarely,chylothorax due to damage to the thoracic duct.Herein,we report a case of suspected thoracic duct cannulation that occurred during left central venous catheter insertion.Fortunately,the patient was discharged without any adverse events related to thoracic duct cannulation.CASE SUMMARY A 46-year-old female patient presented at our department to undergo cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.During anesthesia,we decided to insert a central venous catheter through the left internal jugular vein because the patient already had a chemoport through the right central vein.During the procedure,blood reflux was observed when the needle tip was not within the ultrasound field of view.We did not try to find the tip;however,a guide wire and a central venous catheter were inserted without any resistance.Subsequently,when inducing blood reflux from the distal port of the central venous catheter,only clear fluid,suspected to be lymphatic fluid,was regurgitated.Further,chest X-ray revealed an appearance similar to that of the path of the thoracic duct.Given that intravenous fluid administration was not started and no abnormal fluid collection was noted on preoperative chest X-ray,we suspected thoracic duct cannulation.CONCLUSION It is important to use ultrasound to confirm the exact position of the needle tip and guide wire path.

Malignant otitis externa with subsequent internal jugular vein thrombosis and hypoglossal palsy:a report and review of literature

Inflammation of a part or whole of the temporal bone and surrounding soft tissue is termed as malignant otitis externa,which typically spreads to skull base to involve cranial nerves VII.Rarely can it also effect one or more of cranial nerves IX,X,XI,and XII.We present a case of malignant otitis externa which presented with symptomatic palsy of IX and XII nerves sparing the VII cranial nerve.The patient though later on had internal jugular vein thrombosis,which we presume is due to the involvement of the parapharyngeal space that prompted us to reconsider the diagnosis,and later on,to aggravate the therapy.With proper blood sugar control and appropriate long term antibiotics,not only that the patient is disease free at one year follow up,but the cranial nerve deficits also recovered.Apart from sharing the clinical and management details of this patient,we have reviewed the relevant literature in the discussion,which has shed some light onto some of the interesting facts about this condition and its prognosis.

Massive hemothorax following internal jugular vein catheterization under ultrasound guidance:A case report

BACKGROUND Hemothorax is a rare but life-threatening complication of central venous catheterization.Recent reports suggest that ultrasound guidance may reduce complications however,it does not guarantee safety CASE SUMMARY A 75-year-old male patient was admitted for laparoscopic radical nephrectomy.Under ultrasound guidance,right internal jugular vein catheterization was successfully achieved after failure to aspirate blood from the catheter in the first attempt.Sudden hypotension developed after surgical positioning and persisted until the end of the operation,lasting for about 4 h.In the recovery room,a massive hemothorax was identified on chest radiography and computed tomography.The patient recovered following chest tube drainage of 1.6 L blood.CONCLUSION Hemothorax must be suspected when unexplained hemodynamic instability develops after central venous catheterization despite ultrasound guidance.So the proper use of ultrasound is important.

Thrombosis of the internal jugular vein,a rare entity:A case report and brief review of the literature

Rationale:Thrombosis of the internal jugular vein is an infrequent and underdiagnosed pathology due to the absence of symptoms.If present,the symptoms are frequently manifested as a sensation of pain and cervical tension.Its etiology is variable,including trauma,central catheterization,and hypercoagulable states,among others.Patient’s Concern:A 41-year-old female,previously healthy,was admitted to the emergency room for worsening pain in the left cervical area of 5 d.Previously,she was treated for suspected acute pharyngotonsillitis yet without improvement.Diagnosis:Physical examination revealed a 2 cm in length cervical mass of hard consistency that was painful on palpation and non-fluctuating.Ultrasound study showed thrombosis of the left internal jugular vein.A computed tomography scan revealed that the thrombosis occurred at the cervical portion of the left internal jugular vein as well as the left transverse sinus.Interventions:Hospital admission and treatment with low molecular weight heparin at a dose of 1.5 mg/kg every 24 h.Outcomes:The patient was discharged after 3 d of treatment with vitamin K antagonists.Lessons:Venous thrombosis at the level of the internal jugular vein is an infrequent entity.Clinical suspicion is necessary for the diagnosis given the possibility of absence of symptoms.

Effect of different types of laryngeal mask airway placement on the right internal jugular vein: A prospective randomized controlled trial

BACKGROUND In recent years, with the popularity of laryngeal mask airway(LMA) for the management of clinical anesthesia, the influence of the LMA on the position and blood flow of the internal jugular vein(IJV) has attracted an increasing amount of attention.AIM To investigate the effect of placement of different types of LMA(Supreme LMA,Guardian LMA, I-gel LMA) on the position and blood flow of the right IJV.METHODS This was a prospective randomized controlled trial. A total of 102 patients aged 18-75 years who were scheduled to undergo laparoscopic abdominal surgery with general anesthesia were randomly assigned to three groups: Supreme LMA(group 1), Guardian LMA(group 2), and I-gel LMA(group 3) groups. The main indicator was the overlap index(OI) of IJV and the common carotid artery(CCA)at the high, middle, and low points before and after the placement of the LMA.The second indicators were the proportion of ultrasound-simulated needle crossing the IJV and CCA, and the cross-sectional area and blood flow velocity of the IJV before and after placement of the LMA at the middle point.RESULTS Data from 100 patients were included in the statistical analysis. The OI increased significantly after placement of the LMA in the three groups at the three points(P< 0.01), except group 2 at the low point. In group 2 and group 3, the OI was lower than that in group 1 after LMA insertion at the high point(P < 0.0167). At the middle point, after LMA insertion, the proportion of simulated needle crossing the IJV significantly decreased in all three groups(P < 0.05), and the proportion in group 2 was higher than that in group 3(P < 0.0167). The proportion of simulated needle crossing the CCA or both the IJV and CCA significantly increased in group 1 and group 2(P < 0.05), which increased with no statistical significance in group 3. After LMA insertion, the cross-sectional area of the IJV significantly increased, while the blood flow velocity significantly decreased(P <0.01). There was no significant difference among the three groups.CONCLUSION The placement of Supreme, Guardian, and I-gel LMA can increase the OI, reduce the success rate of IJV puncture, increase the incidence of arterial puncture, and cause congestion of IJV. Type of LMA did not influence the difficulty of IJV puncture. Therefore when LMA is used, ultrasound is recommended to guide the IJV puncture.

Appropriate posture of cancer patients treated with PICC to prevent internal jugular vein ectopic

We aimed to study the appropriate posture of peripherally inserted central catheter （PICC） patients, to reduce the incidence of internal jugular vein heterotopia. Methods： From 2009 to 2013, a total of 290 cases with PICC were enrolled in our study. They were divided into two groups. The patients in control group took regular position, which mean pros- tration, upper limb of tube side was abduction 90°, head moved to puncture side in order to block the internal jugular vein. On the basis of conventional body position putting, posture of patients in observation group was improved, the head remain neutral, and had 180° angle with trunk longitudinal axis, not favor any side. After ensuring the upper limb abduction, had 90° angle with the trunk, then catheter was inserted slowly. The jugular venous catheter heterotopia rate was judged by X.ray results. Results： The jugular venous catheter heterotopia rate of control group and observation was 12.8% and 0.68%, respectively. The difference between two groups was statistically significant （P 〈 0.01）. Conclusion： The body posture improvement can prevent discomfort of patients and reduce the jugular venous catheter heterotopia rate of PICC.

Effect of Head Position Angles on the Blood Flow in the Jugular Vein of Giraffes

The study investigated the effect of the angular position of the head on the blood flow in the jugular vein of giraffes. The vein considered is elastic and collapsible such that its cross-sectional area is not uniform. Transmural pressure causes the blood to move along the vein. Mathematical equations describing the flow were developed, and the vein was considered to be inclined at an angle φ to the horizontal. A finite-difference scheme was used to solve the equations of motion for the flow. The results are presented via relevant tables and plots. Our findings show that a change in the position of the head causes variation in the external pressure, which in turn causes variation in the cross-sectional area of the vein. Moreover, a drop (or increase) in the inertial pressure of the blood may cause the vein to collapse (or distend), which again triggers a change in the pressure.

Internal Jugular Vein Graft after Inadvertent Severing of the Internal Carotid Artery during Carotid Endarterectomy and an Urgent Re-Exploration for Immediate Post-Operative Wound Site Bleeding: A Case Report

Carotid endarterectomy is a well-established treatment for preventing stroke in selected patients. Although there is debate over whether patch angioplasty or primary closure should be used to reconstruct the bifurcation after carotid endarterectomy, there is growing evidence in the literature in favor of patch angioplasty. When compared to primary closure, patch angioplasty during conventional carotid endarterectomy is suggested to lower the incidence of restenosis and recurrent ipsilateral stroke. Various materials have been used as a patch in this procedure, including the saphenous vein, synthetic patches, or less frequently, an internal jugular vein patch where extensive narrowing of the internal carotid artery is evident. In our case, we used an internal jugular vein graft after inadvertent severing the internal carotid artery (ICA) during carotid endarterectomy after the failure of reconstruction with a saphenous vein patch. We also encountered immediate postoperative reactionary hemorrhage following anesthetic reversal, necessitating an urgent re-exploration. The purpose of this case report is neither an attempt to suggest all patients need angioplasty nor to state that an internal jugular vein patch or graft is superior to synthetic material or saphenous veins;rather, it is an attempt to emphasize a potentially effective rescue way to reconstruct inadvertent extensive vascular injury during carotid endarterectomy.

Pulmonary embolism and internal jugular vein thrombosis as evocative clues of Lemierre's syndrome:A case report and review of the literature

Lemierre’s syndrome(LS)is an uncommon condition with oropharyngeal infections,internal jugular vein thrombosis,and systemic metastatic septic embolization as the main features.Fusobacterium species,a group of strictly anaerobic Gram negative rod shaped bacteria,are advocated to be the main pathogen involved.We report a case of LS complicated by pulmonary embolism and pulmonary septic emboli that mimicked a neoplastic lung condition.A Medline search revealed 173 case reports of LS associated with internal jugular vein thrombosis that documented the type of microorganism.Data confirmed high prevalence in young males with Gram negative infections(83.2%).Pulmonary embolism was reported in 8.7% of cases mainly described in subjects with Gram positive infections(OR=9.786;95%CI:2.577-37.168,P=0.001),independently of age and gender.Only four fatal cases were reported.LS is an uncommon condition that could be complicated by pulmonary embolism,especially in subjects with Gram positive infections.

Safety and Feasibility of the Venous Access via Internal Jugular Vein Puncture Approach for Totally Implantable Venous Access Device Placements Compared with Subclavian Vein Puncture

Background: The aim of this study was to evaluate the safety and feasibility of venous access via the internal jugular vein (IJV) for totally implantable venous access device (TIVAD) placements. In Japan, TIVADs are generally placed in position by the percutaneous subclavian vein puncture approach (SVPA). However, this approach causes infrequent intraoperative or postoperative complications. Using the internal jugular vein puncture approach (IJVPA), TIVADs could be placed more easily and safely. Materials and Methods: Fifty-six patients who received TIVADs for chemotherapy of colorectal carcinomas were enrolled in this study. The choice of approach (IJVPA or SVPA) was adopted at the discretion of each doctor in charge of the patient. The operation time, success rate and complications of the two approaches were compared and evaluated. Results: TIVAD placement was successful in all patients. Thirty patients received the device via IJV puncture, but 1 patient required conversion to SVPA. Twenty-six patients underwent SVPA for device placement, but 3 of these patients required conversion to IJVPA. Mean operation time was 34.3 min in IJVPA and 35.2 min in SVPA. The success rate was 96.6% in IJVPA and 88.5% in SVPA. No severe perioperative complications were observed. However, long-term complications were observed in five cases, 3 by IJVPA and 2 by SVPA, but no significant difference in the rate of complications was observed between these two approaches. A catheter-related thrombosis was found by CT scan in 3 patients, two of whom underwent IJVPA (6.7%) and one case underwent SVPA (3.8%). Two patients received simultaneous administration of bevacizumab. Catheter infections occurred in 1 patient who underwent IJVPA (3.3%) and 1 patient who underwent SVPA (3.8%). Conclusions: The IJVPA is a safe and feasible method for TIVAD placement.

Factors Predictive of Right Internal Jugular Vein Cross-Sectional Area Change in Response to Trendelenburg Positioning

Background/Purpose: The right internal jugular vein (RIJV) is the most commonly accessed central venous site in the cardiac operating room. The Trendelenburg position is frequently used to increase the cross-sectional area (CSA) of the RIJV to facilitate its cannulation. However, the extent of change of RIJV CSA in response to Trendelenburg positioning in anesthetized patients and its predictive factors remain unknown. Methods: Thirty-seven patients presented for the cardiac surgery, and 20 ASA I and II surgical patients without a history of cardiac disease (control) were studied. After induction of anesthesia, RIJV CSA was measured both at supine level position and in 10-degree Trendelenburg using vascular ultrasonography. Central venous pressure was measured in cardiac surgery patients only, since the patients in control group did not require invasive lines placement. Results and Conclusions: Body-surface area, central venous pressure, type of surgery and ejection fraction did not show any correlation with the degree of RIJV CSA change. RIJV dilation in response to Trendelenburg was significantly less pronounced, and more variable, in female patients.

Right Internal Jugular Vein Ectasia in African Woman: A Report of 2 Cases

Internal jugular vein (IJV) ectasia is a rare benign disease. It commonly presents as a unilateral, soft, compressible neck swelling that mostly involves the right side. It is usually a childhood disease and believed to be of congenital origin. Accurate diagnosis from careful history, physical examination and radiological study can be made. We report here two cases of IJV ectasia in African adults with right lateral neck mass dilating when increase intrathoracic pressure. Because of its rarity, this entity is frequently ignored or misdiagnosed. This case report intends to stress the importance of keeping IJV ectasia as differential diagnosis in mind in case of lateral neck swellings to avoid invasive investigations and inappropriate treatment. The asymptomatic case management of IJV ectasia is conservative with long-term surveillance.

Surgical outcome after complete repair of tetralogy of Fallot with absent pulmonary valve: comparison between bovine jugular vein-valved conduit and monocusp-valve patch

Background The prognosis of tetralogy of Fallot with absent pulmonary valve (TOF/APV) without operation is poor. We evaluated the surgical outcome of TOF/APV in a single center. Methods Twenty-two TOF/APV patients underwent complete surgical correction in our hospital. Right ventricular outflow tract reconstruction was performed using bovine jugular vein (BJV)-valved conduit implantation (n=10), homograft-valved conduit implantation (n=2), or monocusp-valve patch (n=10). Health-related quality of life (QOL) was evaluated during follow-up. Results The overall survival at 5 and 10 years was 86.4±7.3% (confidence interval 69.4–97.2%). The survival rates were significantly different between patients with and without bronchial stenosis (40 and 100%, P=0.0003, log-rank test). The survival of patients aged>6 months was higher than those≤6 months (100 vs. 40%, P=0.0003, log-rank test). Patients with BJV-valved conduits had higher systolic gradients from the right ventricle to the pulmonary artery (RV–PA) compared to those with monocusp-valve patches. BJV-valved conduit implantation was a risk factor for post-operative pulmonary-valve stenosis. The QOL score for patients with BJV-valved conduits was lower than those with monocusp-valve patches (P<0.05). No reoperation was performed during follow-up. Conclusions Bronchial stenosis and lower age (≤6 months) were the main factors influencing post-operative survival. The use of a BJV-valved conduit was a main reason for RV–PA restenosis;thus, the use of a BJV-valved conduit may increase the need for repeat intervention and decrease the post-operative quality of life.

Anatomic relationship of the internal jugular vein and the common carotid artery in Chinese people

Background Variations in position and relationship between the internal jugular vein （IJV） and the common carotid artery （CCA） may lead to inadvertent artery puncture which could be disastrous during central venous access. We demonstrated the anatomic relationship of the IJV with CCA in order to find the optimal site and avoid damage of CCA. Methods Two hundred and twenty surgical patients were enrolled. We analyzed the distance and relationship between the IJV and CCA at three cross sections （upper border of the thyroid cartilage, cricoid cartilage and second tracheal ring） by ultrasonography and then measured the diameters of the IJV and CCA and the distances from the IJV and CCA to the skin. Results Twenty patients were excluded on the basis of exclusion criteria. From up to down at bilateral neck, the IJV became gradually more superficial while the CCA became deeper. The diameter of the IJV became gradually larger while that of the CCA gradually smaller. The IJV from lateral to the CCA gradually moved to the front of the CCA, so the percent overlap of the IJV and CCA was gradually increased. Compared with the left side at the same transverse scan level, the distance between the CCA and IJV was wider at the right side and the right IJV was wider. The IJV location in 11 patients was medial to the CCA at one or more transverse scan levels. The angle between the IJV and CCA was significantly small in elderly patients. The CCA had already furcated at the level of the upper border of the thyroid cartilage in seven patients at the right side and in 12 patients at the left side. Conclusions There are variations in the position and relationship between the IJV and CCA. It is relatively more difficult to puncture at the left side of the neck, at a lower position or in elderly patients. On the contrary, it is relatively easier to puncture at the right side, at the level of the cricoid cartilage or in younger patients.

Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables

Objective： The subclavian vein （SCV） is usually used to inject the indicator of cold saline for a transpul- monary thermodilution （TPTD） measurement. The SCV catheter being misplaced into the internal jugular （IJV） vein is a common occurrence. The present study explores the influence of a misplaced SCV catheter on TPTD variables. Methods： Thirteen severe acute pancreatitis （SAP） patients with malposition of the SCV catheter were enrolled in this study. TPTD variables including cardiac index （CI）, global end-diastolic volume index （GEDVI）, intrathoracic blood volume index （ITBVI）, and extravascular lung water index （EVLWl） were obtained after injection of cold saline via the misplaced SCV catheter. Then, the misplaced SCV catheter was removed and IJV access was constructed for a further set of TPTD variables. Comparisons were made between the TPTD results measured through the IJV and mis- placed SCV accesses. Results： A total of 104 measurements were made from TPTD curves after injection of cold saline via the IJV and misplaced SCV accesses. Bland-Altman analysis demonstrated an overestimation of ＋111.40 ml/m2 （limits of agreement： 6.13 and 216.70 ml/m2） for GEDVI and ITBVI after a misplaced SCV injection. There were no significant influences on CI and EVLWI. The biases of ＋0.17 L/（min.m2） for CI and ＋0.17 ml/kg for EVLWI were re- vealed by Bland-Altman analysis. Conclusions： The malposition of an SCV catheter does influence the accuracy of TPTD variables, especially GEDVI and ITBVI. The position of the SCV catheter should be confirmed by chest X-ray in order to make good use of the TPTD measurements.