The relationship between the internal jugular vein and common carotid artery in the carotid sheath: the effects of age, gender and side.

The internal jugular vein is often used for central venous catheter placement. The variations in the location of this vein along the major neck vessels (in the carotid sheath) may account for unsuccessful cannulations or iatrogenic arterial injuries. The aim of this study was to delineate the relation of the internal jugular vein and common carotid artery in the lower neck, and to assess the effects of age, gender and side on these anatomical structures. Two-dimensional ultrasonographic examinations of the right and left supraclavicular triangle were performed in 219 adult individuals who had no history of neck surgery or known pathology. The location of the internal jugular vein in relation to the common carotid artery was recorded. An anterolateral location of the internal jugular vein was the most common configuration observed on both sides (84% right side and 91.8% left side) followed by the lateral (14.2% right and 6.4% left) and anterior (1.4% right and 1.8% left) locations. A single case of a medial internal jugular vein was observed on the right side (0.23% of both sides). Subjects with a laterally located internal jugular vein were older than those with an anterolateral configuration (P<0.01). No gender differences were found with regard to these two configurations (P=0.867). The laterally located internal jugular vein was more frequent on right sides (P=0.007). Such information may be potentially useful for clinicians who are managing critically ill patients or patients undergoing hemodialysis.

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients.

AIM: To evaluate portal hypertension parameters in liver cirrhosis patients with and without esophageal varices (EV). METHODS: A cohort of patients with biopsy confirmed liver cirrhosis was investigated endoscopically and with color Doppler ultrasonography as a possible non-invasive predictive tool. The relationship between portal hemodynamics and the presence and size of EV was evaluated using uni- and multivariate approaches. RESULTS: Eighty five consecutive cirrhotic patients (43 men and 42 women) were enrolled. Mean age (+/- SD) was 47.5 (+/- 15.9). Portal vein diameter (13.88 +/- 2.42 vs 12.00 +/- 1.69, P < 0.0005) and liver vascular index (8.31 +/- 2.72 vs 17.8 +/- 6.28, P < 0.0005) were found to be significantly higher in patients with EV irrespective of size and in patients with large varices (14.54 +/- 1.48 vs 13.24 +/- 2.55, P < 0.05 and 6.45 +/- 2.78 vs 10.96 +/- 5.05, P < 0.0005, respectively), while portal vein flow velocity (13.25 +/- 3.66 vs 20.25 +/- 5.05, P < 0.0005), congestion index (CI) (0.11 +/- 0.03 vs 0.06 +/- 0.03, P < 0.0005), portal hypertensive index (2.62 +/- 0.79 vs 1.33 +/- 0.53, P < 0.0005), and hepatic (0.73 +/- 0.07 vs 0.66 +/- 0.07, P < 0.001) and splenic artery resistance index (RI) (0.73 +/- 0.06 vs 0.62 +/- 0.08, P < 0.0005) were significantly lower. A logistic regression model confirmed spleen size (P = 0.002, AUC 0.72) and portal hypertensive index (P = 0.040, AUC 0.79) as independent predictors for the occurrence of large esophageal varices (LEV). CONCLUSION: Our data suggest two independent situations for beginning endoscopic evaluation of compensated cirrhotic patients: Portal hypertensive index > 2.08 and spleen size > 15.05 cm. These factors may help identifying patients with a low probability of LEV who may not need upper gastrointestinal endoscopy.