Abstract
The knowledge of both normal and abnormal anatomy of the veins of the neck may be
important for surgeons performing carotid endarterectomy (CEA), to avoid inadvertent
injury to vascular structures. We present three cases of abnormal course of the internal
jugular vein (IJV) which run anterior to the common carotid artery, named twisted
IJV, that usually run posterolateral to the common carotid artery in patients undergoing
CEA. These twisted IJV cases were detected by preoperative multidetector computed
tomography angiography evaluation. During the CEA procedure, before identifying the
common carotid artery, we dissected the retromandibular space to find the common facial
vein. Then, dissection proceeded along the common facial vein caudally to find the
IJV. After ligation and cutting of the common facial vein, a carotid sheath with the
IJV turned laterally revealed the common carotid artery safely, and CEA was accomplished.
Our clinical experience shows that knowledge of the anatomical anomaly of the IJV
allows safe dissection of the carotid triangle avoiding inadvertent injury to the
vasculature and vagus nerve.
Keywords
internal jugular vein variant - carotid triangle - neck surgery
