Internal Jugular Vein Patency in Patients Undergoing Microvascular Reconstruction

Abstract

The objective of this study was to determine the incidence of internal jugular vein thrombosis in patients undergoing free flap reconstruction and simultaneous neck dissection. Patients underwent Doppler ultrasound examination of their internal jugular veins on postoperative days 1 and 7 after functional neck dissection and free flap transfer. Long-term follow up was obtained at a minimum of 3 months. The incidence of internal jugular vein thrombosis in patients undergoing free flap reconstruction with simultaneous neck dissection is similar to that of patients undergoing just neck dissection. A significant number of these veins recanalize and have excellent long term patency. There does not seem to be a correlation between venous thrombosis and free flap survival.

Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects

“…30 Several of the preceding studies have shown flap survival despite internal jugular vein thrombosis. 36,37 The mechanism by which the flap maintains venous drainage in the presence of apparent internal jugular vein occlusion is not clear. 30 Finally, a branch of the internal jugular vein at the ipsilateral side is usually the first choice of recipient vein.…”

Salvage operations of free tissue transfer following internal jugular venous thrombosis: A review of 4 cases

“…4,5,15À17 Wax et al 3 concluded that there is no correlation between venous thrombosis and flap failure despite possible morbidity of thrombosis. The most important factor in postoperative monitoring is experienced personnel who consistently check the flap at designed intervals.…”

“…Some reports stated that there was no significant difference in the incidence of internal jugular vein thrombosis between right-sided and left-sided anastomoses, 3,18 although some noted that the risk of occlusion is higher in the left internal jugular vein in view of the lower flow and venous pressure. 19,20 In reported cases of flap compromise due to internal jugular vein thrombosis with documentation regarding the side, the incidence was four flaps on the left and two on the right.…”

“…There are some case reports, but large sample studies are few. 2,3,9,11À14 Wax et al 3 concluded that there is no correlation between venous thrombosis and flap failure despite its possible morbidity of thrombosis.…”

Patency assessment of the internal jugular vein after neck dissection

“…MRND was used to treat patients suspected to have metastatic lymph nodes at levels I and II without extracapsular spread. Postoperatively, MRND may lead to occlusion of the IJV 2,3,5,7, [10][11][12]16,18,20 (Table 1), and patency rates vary widely. The IJV often plays an important part in microvascular surgery during head and neck reconstruction.…”