Cece wrote:Interesting. This was in Serbia. It says that no IJV stenoses or abnormal valves were found, so I am guessing the patient was not treated. Has anyone read the full paper? I am wondering if it is a full duplication of separate IJV veins or if they are sharing a common wall. Fenestration of the common wall was once suggested as a treatment for IJV duplication.
My guess, if the patient was not treated at all, is that there may have been an additional missed IJV stenosis in the other IJV or an azygous stenosis. I am used to CCSVI abnormalities coming in multiples. A duplication on the right seems like something the body could compensate for by using the left jugular for more of the flow.
The way a duplication can affect the hemodynamics is if the second IJV fills up and then presses on the first IJV, cutting off flow in that IJV.
Cece wrote:Technically it was Dr. Sclafani's explanation....
He compared the duplication to a windsock, that distends and presses on the jugular wall. He has seen this on IVUS.
What Dr. Sclafani is describing is "an incomplete duplication of 206 cm of the jugular vein centrally. it shares a common wall with the true jugular vein. and an orifice with the sublcavian/inominate." It was not the same as a fully duplicated IJV, as described and imaged in this article: http://www.ispub.com/journal/the_intern ... ature.html
Still not sure which sort of duplication is seen in this patient. My guess would be that it is the windsock version that Dr. Sclafani described. A full duplication, as in the linked article, might actually increase outflow rather than limit it.
The appearance of an internal jugular vein on CTA images is characteristic. The vein begins its course with a single lumen (A, B). It then bifurcates forming two distinct lumena (C). As the vein continues caudally, it once again becomes a single vessel (D, E). Panel F shows the fenestrated internal jugular vein reformatted in a single sagittal, oblique plane.
The internal jugular vein is the great collecting vein of the cranium, face, and anterior neck. It is the continuation of the sigmoid sinus beginning at the jugular foramen, where it drains most of the venous blood from the brain as well as CSF. The internal jugular vein continues inferiorly from the skull base until it joins the subclavian vein to form the brachiocephalic vein.
Fenestration of the internal jugular vein is uncommon. There have been five previously published reports of seven cases of a fenestrated internal jugular vein (2–6). One study estimated that fenestration of the internal jugular vein occurs in as much as 0.4% of the population (2).
Duplication of the internal jugular vein is a rare congenital anomaly. The vein divides into two branches that separately enter the subclavian vein. Almost always it involves the upper third of the vein., In our case, the duplication was 2 cm below the base of the skull.
Duplication of the internal jugular vein is usually reported in association with phlebectasia, which is a soft non-pulsatile cervical swelling that increases in size during Valsalva maneuver.  In our case, no aneurysm or phlebectasia was observed.
Fenestrations or duplications of the IJV are rare variations,
but there is an important difference between fenestration
and duplication. Downie et al. (10) suggested
that the term ‘duplication’ should be used for those cases
where the branches of the anomalous vessel, regardless
of artery or vein, remain separate along the whole
length of their normal course and that the term ‘fenestration’
should be used for those cases where branched
vessels rejoin a single normal vessel.
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