Anatomic relationship of the internal jugular vein and the common carotid artery applied to percutaneous transjugular procedures.

Purpose: To demonstrate the anatomic relationship of the internal jugular vein (IJV) with the common carotid artery (CCA) in order to avoid inadvertent puncture of the CCA during percutaneous central venous access or transjugular interventional procedures.

Methods: One hundred and eighty-eight consecutive patients requiring either central venous access or interventional procedures via the IJV were included in the analysis. The position of the IJV in relation to the CCA was demonstrated by portable ultrasonography. The IJV location was recorded in a clock-dial system using the carotid as the center of the dial and the angles were measured. Outcomes of the procedure were also recorded.

Results: The IJV was lateral to the CCA in 187 of 188 patients and medial to the CCA in one patient. The left IJV was at the 12 o'clock position in 12 patients (6%), the 11 o'clock position in 17 patients (9%), the 10 o'clock position in 142 patients (75%) and at the 9 o'clock position in 17 patients (9%). The right IJV was at the 12 o'clock position in 8 patients (4%), the 1 o'clock position in 31 patients (16%), the 2 o'clock position in 134 patients (71%) and the 3 o'clock position in 17 patients (9%). In one patient the left IJV was located approximately 60 degrees medial to the left CCA; this was recorded as 2 o'clock on the left since it is opposite to the 10 o'clock position.

Conclusion: Knowledge of the IJV anatomy and relationship to the CCA is important information for the operator performing an IJV puncture, to potentially reduce the chance of laceration of the CCA and avoid placement of a large catheter within a critical artery, even when ultrasound guidance is used.