Anatomical relationship between the common carotid artery and the internal jugular vein during head rotation

Abstract

This study investigated the anatomical relationship between the common carotid artery and internal jugular vein during head rotation for the effective performance of percutaneous transjugular procedures. The subjects included 30 volunteers who had never undergone internal jugular vein cannulation. In the supine position, two-dimensional ultrasonographic images of the right internal jugular vein and common carotid artery were obtained, 2 and 4 cm above the clavicle, along the lateral border of the sternal head of the sternocleidomastoid muscle. Ultrasonographic images were examined for head rotation at 0°, 15°, 30°, 45°, 60°, and 75° from the midline to the left. The percentage of overlap of the common carotid artery by the internal jugular vein and the flattening of the internal jugular vein at each head rotation position were measured and evaluated. The overlap of the common carotid artery by the internal jugular vein significantly increased at ≥45° of head rotation 2 cm above the clavicle (P < 0.01) and at ≥30° of head rotation 4 cm above the clavicle (P < 0.01), compared with that observed in the neutral position. The flattening of the internal jugular vein significantly decreased at ≥45° of head rotation 2 cm above the clavicle (P < 0.01) and at ≥30° of head rotation 4 cm above the clavicle (P < 0.01). Head rotation should be kept to <45° at 2 cm above the clavicle and <30° at 4 cm above the clavicle to decrease the risk of accidental puncture of the common carotid artery during internal jugular vein puncture. Moreover, flattening of the internal jugular vein gradually decreases during head rotation to the side.

Keywords: Cannulation of the central veins; carotid artery; head rotation; internal jugular vein; vascular anatomy.

Figures

Figure 1

Ultrasonographic study of vessel overlap using an adjustable protractor to verify the angle of head rotation. A high-frequency linear probe was placed 2 and 4 cm above the clavicle while the head was turned 0°, 15°, 30°, 45°, 60°, and 75°. An adjustable protractor was used to verify the angle of head turn

Figure 2

Ultrasonographic imaging of the right internal jugular vein (IJV) and common carotid artery (CCA). a: %overlap = overlap distance (B)/CCA diameter (A) b: Flattening = {horizontal diameter (C) – vertical diameter (D)}/horizontal diameter (C)

Figure 3

Correlation of the right internal jugular vein (IJV) and common carotid artery (CCA) using ultrasonography, 4 cm above the clavicle. As the subject’s head was rotated to the left, the percentage overlap of the CCA by the IJV increased and the flattening of the IJV gradually decreased, to approximate a perfect circle. (a) 0°, (b) 15°, (c) 30°, (d) 45°, (e) 60°, (f) 75°

Figure 4

Line graph of the effect of head rotation on percentage overlap. The percentage overlap was significantly higher with a head rotation of 45°, 2 cm above the clavicle and with a head rotation of 30°, 4 cm above the clavicle, compared with that observed in the neutral position. As the head was rotated further to the left, the percentage overlap increased further

Figure 5

Line graph of the effect of head rotation on the shape of the internal jugular vein. The flattening was significantly lower with a head rotation of 45°, 2 cm above the clavicle and with a head rotation of 30°, 4 cm above the clavicle, compared with that observed in the neutral position. As the head was rotated further to the left, the flattening decreased further