INTERNAL JUGULAR VEIN THROMBOSIS SURGERY

Thrombosis of the internal jugular (IJ) vein is an under diagnosed condition that may occur as a complication of head and neck infections, surgery, central venous access, local malignancy, polycythemia, hyperhomocysteinemia, neck massage, and intravenous drug abuse. It is also reported to occur spontaneously. IJ thrombosis itself can have serious potentially life-threatening complications that include systemic sepsis, chylothorax, papilledema, airway edema, and pulmonary embolism. The diagnosis often is very challenging and requires, first and foremost, a high degree of clinical suspicion.

Thrombosis of the internal jugular (IJ) vein is an under diagnosed condition that may occur as a complication of head and neck infections, surgery, central venous access, and intravenous drug abuse. IJ thrombosis itself can have serious potentially life-threatening complications that include systemic sepsis and pulmonary embolism. The diagnosis often is very challenging and requires, first and foremost, a high degree of clinical suspicion.

Thrombosis is the formation of a blood clot (thrombus) inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot, because the first step in repairing it is to prevent loss of blood. If that mechanism causes too much clotting, and the clot breaks free, an embolus is formed.

The pathogenesis for venous thrombosis requires the presence of one or more factors that was described in Virchow’s triad. They are endothelial injury, stasis, and hypercoagulability of the blood.

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For anterior surgical approaches to cervical spine, careful dissection of the soft tissues is important to avoid damaging the vital structures; hence a thorough knowledge is needed about the anatomy of the neck. In situations where instrumentation is needed, retraction on soft tissue, including the carotid artery and internal jugular vein, may be necessary for extended duration.

Studies have shown that intra operative retraction during anterior cervical spinal surgery will cause a significant decrease in cross-sectional area of the common carotid artery and hence the blood flow. This observation may also apply to the internal jugular vein.

Repeated neck traction as a modality of treatment has been reported as a cause of internal jugular thrombosis. Alternation of the venous blood flow in this situation may be one of the contributing factors to the thrombosis.

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