Split internal jugular vein: surgical and radiological implications

Internal Jugular Vein Fenestration and Duplication: Anatomical Findings, Prevalence, and Literature Review

Background: Comprehensive knowledge of the internal jugular vein (IJV) regarding its anatomical variations and the pattern of its course is valuable for preventing unexpected injuries during surgical procedures or central venous access. IJV anatomical anomalies such as fenestration and duplication are rare, mainly represented by case reports, and intraoperative findings.

Objective: To present two additional cases of IJV anomalies and highlight its clinical presentation, anatomical characteristics, management, and prevalence through an extensive literature review.

Methods and Case Reports: From January 2017 to December 2018, we retrospectively collected data of 221 patients undergoing neck dissection (ND) procedures and identified two patients with IJV anomalies (fenestration and duplication) providing a clinical prevalence of ~0.9%. The IJV fenestration referred to an IJV bifurcation that reunites proximal to the subclavian vein, whereas in the IJV duplication both branches remain separated. In both of our cases, the spinal accessory nerve (SAN) crossed the window between the IJV branches.

Conclusion: Anatomical variations are more likely to be identified intraoperatively or incidentally, and due to the risk of SAN and vascular injury, special attention should be taken to identify them preoperatively in order to reduce the risk of iatrogenic injury and unexpected complications.

Internal jugular vein agenesis: a rare vascular abnormality and incidental finding. A case of internal jugular vein agenesis in a 52-years old male

We report a case of vascular malformation arising from internal jugular vein discovered during radiological investigations for restaging of metastatic colon carcinoma of an adult male patient. Congenital absence of internal jugular vein is extremely uncommon. These developmental anomalies in general population are seen in about 0.05%-0.25%. The awareness of these vascular anomalies is extremely important to avoid unsafe complications, primarily in oncological patients, whom usually require the incannulation of neck veins for diagnostic procedures or intravenous therapy administration.

Surgical review of the anatomical variations of the internal jugular vein: an update for head and neck surgeons

BACKGROUND

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.

METHODS

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.

FINDINGS

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.