Comparison of the diameter, cross-sectional area, and position of the left and right internal jugular vein and carotid artery in adults using ultrasound

Bos, Michaël J.; Loon, Fredericus H. J. van; Heywood, L.; Morse, Mitchell P.; Zundert, André van

doi:10.1016/j.jclinane.2015.12.034

Cited by 16 publications

(13 citation statements)

References 22 publications

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“…The IJVs are commonly found to be asymmetrical, and many studies quote 68%-80% dominance of the right IJV outflow. [28][29][30][31] In accordance with this, we found that the right IJV blood flow was higher than that in the left. However, contrary to our hypothesis was the fact that the right IJV blood flow was actually less at an individual patient's optimal HOB position (the position that provided the low- est ICP and the highest CPP) compared with the same individual's nonoptimal position on both postinjury days.…”

Section: Discussionsupporting

confidence: 78%

Head of bed elevation in pediatric patients with severe traumatic brain injury

Lang

Valeri

Zhang

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEHead of bed (HOB) elevation to 30° after severe traumatic brain injury (TBI) has become standard positioning across all age groups. This maneuver is thought to minimize the risk of elevated ICP in the hopes of decreasing cerebral blood and fluid volume and increasing cerebral venous outflow with improvement in jugular venous drainage. However, HOB elevation is based on adult population data due to a current paucity of pediatric TBI studies regarding HOB management. In this prospective study of pediatric patients with severe TBI, the authors investigated the role of different head positions on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebral venous outflow through the internal jugular veins (IJVs) on postinjury days 2 and 3 because these time periods are considered the peak risk for intracranial hypertension.METHODSPatients younger than 18 years with a Glasgow Coma Scale score ≤ 8 after severe TBI were prospectively recruited at a single quaternary pediatric intensive care unit. All patients had an ICP monitor placed, and no other neurosurgical procedure was performed. On the 2nd and 3rd days postinjury, the degree of HOB elevation was varied between 0° (head-flat or horizontal), 10°, 20°, 30°, 40°, and 50° while ICP, CPP, and bilateral IJV blood flows were recorded.RESULTSEighteen pediatric patients with severe TBI were analyzed. On each postinjury day, 13 of the 18 patients had at least 1 optimal HOB position (the position that simultaneously demonstrated the lowest ICP and the highest CPP). Six patients on each postinjury day had 30° as the optimal HOB position, with only 2 being the same patient on both postinjury days. On postinjury day 2, 3 patients had more than 1 optimal HOB position, while 5 patients did not have an optimal position. On postinjury day 3, 2 patients had more than 1 optimal HOB position while 5 patients did not have an optimal position. Interestingly, 0° (head-flat or horizontal) was the optimal HOB position in 2 patients on postinjury day 2 and 3 patients on postinjury day 3. The optimal HOB position demonstrated lower right IJV blood flow than a nonoptimal position on both postinjury days 2 (p = 0.0023) and 3 (p = 0.0033). There was no significant difference between optimal and nonoptimal HOB positions in the left IJV blood flow.CONCLUSIONSIn pediatric patients with severe TBI, the authors demonstrated that the optimal HOB position (which decreases ICP and improves CPP) is not always at 30°. Instead, the optimal HOB should be individualized for each pediatric TBI patient on a daily basis.

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Section: Discussionsupporting

confidence: 78%

Head of bed elevation in pediatric patients with severe traumatic brain injury

Lang

Valeri

Zhang

et al. 2020

Journal of Neurosurgery: Pediatrics

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“…However, contrasting data have been reported regarding the asymmetry of the IJV in human beings [40,4142]. Indeed, some studies have reported that right-side IJV dimensions were greater than left-side dimensions [35][36][37]. In contrast, in other studies, diameters did not differ at rest, whereas significant differences were observed in children during the Valsalva manoeuvre [34,38].…”

Section: Discussionmentioning

confidence: 97%

“…In human medicine, cannulation of the left IJV is associated with a perceived increased level of difficulty when compared with the contralateral IJV. Such increased difficulty has been explained by either a smaller diameter or a more anterior position relative to the corresponding carotid artery of the left IJV [35]. However, contrasting data have been reported regarding the asymmetry of the IJV in human beings [40,4142].…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic assessment of normal jugular veins in Standardbred horses

et al. 2019

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Background: Ultrasonography (US) is the recommended imaging technique to evaluate jugular veins. This prospective randomized clinical study was designed to collect a series of B-mode US measurements of manually distended jugular veins in healthy Italian Standardbreds and to find possible correlations between ultrasound measurements and animal morphometric characteristics. Forty-two horses, eight males and 34 females (range 3-22 years; bodyweight 494.4 ± 41.7 kg), were included in the study. The diameters and wall thicknesses of both jugular veins were measured at three different sites of the neck. The differences in ultrasound measurements based on scans, age, gender, side, and site of the neck were evaluated by ANOVA or by the Kruskal-Wallis test. The effects of the morphometric measures on each ultrasound parameter were evaluated by MANOVA (P < 0.05). Results: The ultrasound measurements did not differ significantly between the three different sites or between genders; hence, they were pooled together in the results. On the transverse scan, the mean dorsoventral and lateromedial diameters were 1.58 ± 0.23 and 2.20 ± 0.25 cm, respectively; the mean superficial and deep wall thicknesses (SWT and DWT) were 0.07 ± 0.01 and 0.08 ± 0.01 cm, respectively. On the longitudinal scan, the mean dorsoventral diameter was 1.59 ± 0.26 cm, and the SWT and DWT were both 0.08 ± 0.01 cm. Neck length, from the caudal edge of the mandible to the thoracic inlet, was related to the dorsoventral diameter in both longitudinal and transverse scan and to the SWT and DWT in transverse scan, whereas height at the withers (measured with tape) and estimated weight were related to the wall thickness. Dividing the subjects into groups by age in years ("young" 3-7, "mature" 8-14, "old" > 14), differences were found for the lateromedial diameter in the transverse scan and the SWT on the longitudinal scan. The main limitation of this study was that only one operator performed the measurements. Conclusion: The US measurements of the jugular veins and their relationship with morphometric measures reported in this manuscript might be considered as guidelines both for early diagnosis and monitoring jugular vein abnormalities in healthy Italian Standardbred horses.

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“…Moreover, the etiologies of IJVS are not fully understood. To the best of our knowledge, venous wall is thinner than that of artery, which lacks smooth muscle and elastic fibers, whereby, veins are more vulnerable to deform under extrinsic compression [10]. Therefore, external structures oppression may be one of the most important etiologies of IJVS.…”

Section: Introductionmentioning

confidence: 99%

Internal jugular vein stenosis associated with elongated styloid process: five case reports and literature review

Sun

Chan

et al. 2019

BMC Neurol

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Background Internal jugular vein stenosis (IJVS), characterized by a series of clinical manifestations, such as head and neck symptoms, visual and ear symptoms, as well as sleep disorder, has been receiving attention in recent years. However, its’ etiologies are not fully understood. Case presentation We report a cases series of IJVS induced by styloid oppression. We define it as the stylo-jugular type of Eagle syndrome (ES). Conclusions Our study reveals that external oppression, especially by styloid process, is an important etiology of IJVS. The stylo-jugular ES diagnosis can be identified by Computed tomography venography. Whether stylo-jugular ES can be corrected by styloidectomy requires further investigation.

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Comparison of the diameter, cross-sectional area, and position of the left and right internal jugular vein and carotid artery in adults using ultrasound

Cited by 16 publications

References 22 publications

Head of bed elevation in pediatric patients with severe traumatic brain injury

Head of bed elevation in pediatric patients with severe traumatic brain injury

Ultrasonographic assessment of normal jugular veins in Standardbred horses

Internal jugular vein stenosis associated with elongated styloid process: five case reports and literature review

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