Explore the vast range of titles available.

Purpose The use of real-time ultrasound (US) has been shown to reduce complications of central venous (CV) catheterization. However, complication rates have not been compared according to insertion points for CV catheterization using US. Accordingly, this study aimed to compare the complication rates of internal jugular vein (IJV) with those of subclavian vein (SCV) catheterization. Methods Three tertiary academic hospitals in South Korea participated in this multicenter, randomized study. A total of 1484 patients were preoperatively randomized into two groups. The IJV group ( n  = 742) was cannulated via the right IJV, and the SCV group ( n  = 742) was cannulated via the right SCV under US guidance. The primary outcome measure was total complication rate. Secondary outcomes included access time for the first attempt, number of attempts, and catheter position. Results The total complication rate did not demonstrate a significant difference between the IJV (0.1%) and SCV (0.7%) groups ( P  = 0.248). In the IJV group, arterial puncture occurred in 0.1% of patients; in the SCV group, arterial puncture occurred in 0.6% and pneumothorax in 0.1%. The success rate on the first attempt was significantly higher in the IJV group (98.4%) than in the SCV group (95.9%) ( P  = 0.004). The access time for the first attempt ( P  < 0.001) and the median number of attempts ( P  = 0.006) were significantly lower in the IJV group than in the SCV group. More catheter misplacements were observed in the SCV group (5.9%) than in the IJV group (0.4%) ( P  < 0.001). Conclusion Results demonstrated that the complication rates of IJV and SCV catheterizations using US are very low, showing no superiority of the SCV approach compared to the IJV.

The use of ultrasound (US) has been proposed to reduce the number of complications and to increase the safety and quality of central venous catheter (CVC) placement. In this review, we describe the rationale for the use of US during CVC placement, the basic principles of this technique, and the current evidence and existing guidelines for its use. In addition, we recommend a structured approach for US-guided central venous access for clinical practice. Static and real-time US can be used to visualize the anatomy and patency of the target vein in a short-axis and a long-axis view. US-guided needle advancement can be performed in an \"out-of-plane\" and an \"in-plane\" technique. There is clear evidence that US offers gains in safety and quality during CVC placement in the internal jugular vein. For the subclavian and femoral veins, US offers small gains in safety and quality. Based on the available evidence from clinical studies, several guidelines from medical societies strongly recommend the use of US for CVC placement in the internal jugular vein. Data from survey studies show that there is still a gap between the existing evidence and guidelines and the use of US in clinical practice. For clinical practice, we recommend a six-step systematic approach for US-guided central venous access that includes assessing the target vein (anatomy and vessel localization, vessel patency), using real-time US guidance for puncture of the vein, and confirming the correct needle, wire, and catheter position in the vein. To achieve the best skill level for CVC placement the knowledge from anatomic landmark techniques and the knowledge from US-guided CVC placement need to be combined and integrated.

Modified combined short and long axis method (MCSL) can replace oblique axis in-plane method (OA-IP) for internal jugular vein cannulation (IJVC). This randomized, non-inferiority study estimated the efficacy of MCSL compared with OA-IP in right IJVC. Patients (18-75 yr. old) undergoing right IJVC under local anesthesia were randomly assigned to MCSL or OA-IP group. The primary outcome is the event of first needle pass without posterior vessel wall puncture (PVWP). Secondary outcomes included needle attempts, success rate, puncture and cannulation time, needle visualization, probe placement difficulty and complications. Among 190 randomized patients, 187 were involved in the analysis. The first needle pass without PVWP was 85(89.47%) in the MCSL and 81 (85.26%) in the OA-IP (p = 0.382), with a mean rate difference of 4.2% (95% confidence interval: -5.2-13.6), which confirmed the non-inferiority with the margin of -8%. MCSL group exhibited shorter procedure time and lower complications than OA-IP group. No significant differences were discovered between groups in needle attempts, success rate, incidence of probe placement difficulty and needle visualization. MCSL is non-inferior to OA-IP in first needle pass without PVWP in adults who underwent elective right IJVC and associate with less complications and shorter operating time. ChiCTR, ChiCTR2100046899.

The internal jugular vein (IJV) is of utmost importance during various surgical and endovascular approaches, including central access. It descends through the parapharyngeal space, carotid triangle, and sternocleidomastoid region. The anatomical variables of the IJV are mainly related to its calibre and dominance, number of venous channels (i.e., duplications and fenestrations), and compression sites. Specific compressions of the IJV are not exclusively due to the jugular nutcracker between the styloid process (SP) of the temporal bone and the C1 transverse process, which, in turn, should not be granted the eponym of Eagle. The possible morphologies of the SP and ossified stylohyoid chain are discussed here. Additionally, the digastric and sternocleidomastoid muscles, the hyoid, and the distorted carotid arteries may compress the IJV, thereby raising intracranial pressure. Here, a case is documented with a long inferior petrosal sinus adjacent to the IJV, both compressed into the C1–styloid nutcracker, which is an absolute novelty. Multiple compression sites of the IJV are supported here with original evidence. All anatomical variables of the IJV are relevant, as they may lead to stenoses or interfere with IJV cannulation. In rare cases of IJV agenesis, multiple compression sites on the opposite side may significantly alter bilateral cerebral drainage. Different methods may be used to decompress a stenotic IJV, including styloidectomy. In conclusion, the anatomical variables of the IJV should be acknowledged by practitioners and documented on a case-by-case basis.

Ultrasound (US) assessment of the internal jugular vein (IJV) to measure ultrasound jugular venous pressure (uJVP) has been proposed as a promising non-invasive tool for evaluating hydration status. However, a standardized method for uJVP measurement is currently lacking. This cross-sectional study compared 4 previously described IJV-US methods in healthy, euvolemic volunteers. Methods 1 and 2 use transverse view, measuring uJVP where IJV is (1)smaller than common carotid artery or (2)collapsed throughout the respiratory cycle. Methods 3a/b use longitudinal view, measuring at the tip(3a) or base(3b) of the IJV tapering portion. US assessment was conducted by 2 independent, blinded investigators at individualized head-of-bed elevation angle according to standardized procedures. Endpoints were: a)percentage of participants with measurements differing >1 standard deviation(SD) from the previously described mean (6.5 ± 1.5 cmH₂O) for euvolemic patients, b)reproducibility and c)feasibility. 30 participants(50% females) were included. Median uJVP(IQR) was 3.8 cmH₂O(3.0-4.0), 4.5 cmH₂O(3.8-5.3), 3.9 cmH₂O(3.3-4.5), and 3.3 cmH₂O(2.8-3.5) for methods 1-3b. uJVP differed >1SD in 17/30(56.7%), 3/14(21.4%), 14/29(51.7%) and 25/30available assessment pairs(83.3%), respectively. Reproducibility for methods 1-3b was 18/30(60.0%), 7/30(23.3%), 19/30(63.3%) and 25/30 participants(83.3%). Assessment was feasible in 30/30 participants(100%) for methods 1 and 3b, 29/30(97%) for method 3a and 14/30(47%) for method 2. The longitudinal method measuring uJVP at the base of tapering portion showed the highest reproducibility and feasibility. Overall, measured uJVP values were consistently within the upper threshold for normal central venous pressure, but lower than the previously described values, supporting the use of uJVP for detecting hypervolemia, but not hypovolemia.

Background Centrally Inserted Central Catheter (CICC) placing procedure is challenging in the pediatric population, especially in newborns and infants, leading to lower success and higher complication rates than in adults. The aim of this study was to compare three approaches: open technique, SELDINGER’S technique with surgical isolation of the vein, and percutaneous ultrasound-guided CICC insertion for central line insertion in infancy as regards safety, success of cannulation, technique time, and preservation of the patency of the internal jugular vein (IJV). Methods This prospective randomized cohort study was conducted after approval of the Ethical Committee of Tanta University Hospital with approval code: 36264MS38/1/23 (clinical trial ID: NCT06862492 and date: 03/05/2025). This study adheres to CONSORT guidelines. This study included 105 infants in need of CVC insertion over a period of 6 months. They were randomly allocated into three equal groups; group A underwent CICC insertion using the open surgical technique, group B underwent SELDINGER’S technique with surgical isolation of the vein, and group C underwent percutaneous ultrasound-guided CICC insertion. Results Patency was significantly higher in SELDINGER’S technique with surgical isolation of the vein and percutaneous ultrasound-guided techniques compared to the open surgical technique ( P  = 0.003, < 0.001). There was a significant negative correlation between patency of IJV and duration of CICC placement ( r  = -0.238, P  = 0.010) and with the number of trials to success of the cannulation ( r  = -0.252, P  = 0.006). The technique time was significantly shorter in the percutaneous ultrasound-guided technique compared to open surgical and SELDINGER’S technique with surgical isolation of the vein ( P  < 0.001, < 0.001). SELDINGER’S technique with surgical isolation of the vein was a significantly shorter technique time when compared to the open surgical technique ( P  < 0.001). Conclusions US-guided catheterization of the IJV shows more advantages in the form of a less time-consuming technique with a high first attempt and insertion success rate and fewer trials compared to CICC insertion using either open surgical technique or SELDINGER’S technique with surgical isolation of the vein. Trial registration Current Controlled Trials NCT06862492 and date: 03/05/2025.

Background The cause of facial pain often remains unknown after ruling out dental disorders and arterial compression of the trigeminal nerve. New pathologic models and treatment options are needed. Method Review of 30 patients with unexplained facial pain who were diagnosed with internal jugular vein (IJV) entrapment. Results Mean age 48.8 ± 12.8 years, duration of symptoms 68.4 ± 100.4 months, women (28/30, 93%). Symptom laterality: left only (11/30, 37%), right only (8/30, 27%), bilateral equally (7/30, 23%), left worse than right (3/30, 10%), right worse than left (1/30, 3%). Facial pain lateralized to the side of underlying venous compression in 19/30 (63%) patients or was unilateral with underlying bilateral compressions in 9/30 (30%). The IJV obstructed at the atlas (lateral process of the atlas, styloid process, posterior belly digastric muscle), between muscles in the mid‐neck (sternocleidomastoid, omohyoid, and anterior scalene), and at the thoracic outlet. This led to dilation of the superior petrosal sinus that abuts the trigeminal nerve and shunting through vertebral veins that congested the lower brainstem and cervical spinal cord where the spinal trigeminal nucleus originates and descends. Targeting the IJV obstruction with physical therapy, neurotoxin injections in the neck, and surgical decompression significantly improved facial pain in most patients (20/30, 67%) but was too advanced in some to achieve meaningful relief. Conclusion Increasing awareness of venous outflow obstruction as a contributor to facial pain could explain complex regional neurological symptoms, provide an option beyond oral medications, and lead to earlier diagnosis when the pathology is amenable to treatment.

Aims This study aimed to characterize the clinical features of headache in patients with non‐thrombotic internal jugular vein stenosis (IJVS) and to identify associated risk factors. Methods This retrospective study consecutively enrolled patients with imaging‐confirmed non‐thrombotic IJVS from January 2021 through July 2024. Participants were divided into IJVS‐headache and IJVS‐without‐headache groups based on clinical symptoms. Demographic, clinical, neuroimaging, and treatment data were reviewed in detail. Univariate and multivariate logistic regression analyses were performed to determine risk factors for headache. Results Among 283 eligible patients (median age: 51 years in the IJVS‐headache group vs. 56 years in the IJVS‐without‐headache group, p < 0.001), 65.02% reported headache. Most headaches were chronic (82.07%), generalized (85.87%), and moderate in intensity (53.26%), with notable daily life impact (57.61%). Univariate analysis showed that headache was significantly associated with visual disturbances (p = 0.010), elevated cerebrospinal fluid opening pressure (p < 0.001), high jugular bulb (p = 0.007), and severe scalp vein dilation (p < 0.001), but inversely associated with severe vertebral vein expansion (p < 0.001). Multivariate regression revealed that high jugular bulb (OR = 3.144, 95% CI: 1.083–9.123, p = 0.035), severe scalp vein dilation (OR = 2.142, 95% CI: 1.068–4.294, p = 0.032), and protein C or S deficiency (OR = 5.984, 95% CI: 1.196–29.928, p = 0.029) were independent risk factors, whereas severe vertebral vein expansion was protective (OR = 0.184, 95% CI: 0.092–0.366, p < 0.001). Conclusions Headache represents a prevalent and often disabling symptom in non‐thrombotic IJVS, underpinned by distinctive vascular and hematologic profiles. Identification of high‐risk patients based on neuroimaging and thrombophilia screening may facilitate personalized interventions and improve symptom control. Approximately two‐thirds of non‐thrombotic IJVS patients experienced headache, generally moderate, chronic, and diffuse. Identifying clinical and neuroimaging risk factors of headache may help guide individualized management strategies to reduce headache occurrence.

Background Methods for reliably predicting hypotension in patients during general anesthesia induction are currently lacking. Deep inhalation has been shown to enhance the variability of the internal jugular vein (IJV). In this study, we aim to investigate the relationship between internal jugular vein variability (IJVV) during deep inhalation and the extent of blood pressure decrease during propofol induction, as well as the potential of utilizing IJVV as a guide for pre-anesthesia fluid resuscitation. Methods Before general anesthesia induction, bedside ultrasonic measurement was performed to evaluate the maximum diameter (IJVmax-D) and minimum diameter (IJVmin-D) of the IJV and the maximum cross-sectional area (IJVmax-A) and minimum cross-sectional area (IJVmin-A), and then calculated the IJV diameter variability (IJVV-D) and IJV area variability (IJVV-A). A receiver operating characteristic (ROC) curve was used to determine the diagnostic value of IJVV-D and IJVV-A for predicting propofol induced hypotension (blood pressure decreased ≥ 20%) and calculate the cut-off value. The following prospective randomized controlled trial aimed to compare the incidence of anesthesia-induced hypotension between the IJVV-D or IJVV-A guided fluid administration (Group A) and the standard fluid administration group (Group B) in patients with the variability value > optimal cut-off value. The occurrence rate of hypotension during the propofol induction period was observed and compared between the two groups. Results A total of 60 patients were included in the final analysis. A significant strong correlation exists between IJVV-A and the degree of blood pressure decrease during deep inhalation ( r  = 0.858, p  < 0.001). The AUC of IJVV-A was 0.900 (95% CI 0.821–0.979, p  < 0.001) with a cut-off value of 23.42% (sensitivity: 81.5%, specificity: 84.8%). At the same time, a total of 87 patients with IJVV-A > 23.42% during deep inhalation were included in the data analysis. The incidence of hypotension in Group A was 26.8%, compared to 63.0% in Group B, revealing a statistically significant difference ( P  < 0.001). Conclusions A significant relationship was observed between IJVV levels during deep inhalation and the blood pressure decline following propofol induction. Administering IJVV-A guided fluid infusion can significantly reduce propofol-induced hypotension by keeping the IJVV-A less than 23.42% during deep inspiration. Trial registration Successfully registered on Clinicaltrials.gov on November 1, 2023 (NCT06112769) and on August 1, 2024 (NCT06641505).

The internal jugular vein is one of the major vessels of the neck. The anatomy of this vessel is considered to be relatively stable. It is an important landmark for head and neck surgeons as well as the anaesthetists for both diagnostic and therapeutic purposes. We present two case reports of the posterior tributary of the internal jugular vein and review the surgical literature regarding anatomical variations of the vein. A total of 1197 patients from 27 published papers were included in this review. Of these patients, 99.6% had neck surgery and the rest were cadaveric dissections. Anatomical variations of the internal jugular vein were found in 2% of the patient cohort (n = 40). The majority of these patients had either bifurcation or fenestration of the vein. The posterior tributary of the internal jugular vein is unusual and is scarcely reported in the literature (three cases). Knowledge of variations in the anatomy of the internal jugular vein assists surgeons in avoiding complications during neck surgery and preventing morbidity. Two rare cases of posterior branching of the internal jugular vein and experience of other surgeons are demonstrated in this extensive review.