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CC BY-NC-ND 4.0 · Asian J Neurosurg 2025; 20(01): 149-154
DOI: 10.1055/s-0044-1791841
Case Report

Carotid Endarterectomy with Twisted Internal Jugular Vein Located Anterior to the Common Carotid Artery

Arumu Endo
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Terushige Toyooka
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Kazuya Fujii
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Satoru Takeuchi
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Toru Yoshiura 
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Masaya Nakagawa
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Yohei Otsuka
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Arata Tomiyama
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
,
Kojiro Wada
1   Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan
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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

Authors' Contributions

A.E. was responsible for the investigation and drafting of the original manuscript. T.T., K.F., S.T., T.Y., M.N., Y.O., and A.T. were involved in the investigation. K.W. contributed through conceptualization, supervision, and provided oversight for the review and editing of the manuscript, along with participation in the investigation.


Patients' Consent

All patients provided written consent for the publication of this case report.




Publication History

Article published online:
18 October 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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