'IJV blowout complicating head and neck surgery' article

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'IJV blowout complicating head and neck surgery' article

Postby Cece » Thu Jul 26, 2012 4:00 pm

http://www.ncbi.nlm.nih.gov/pubmed/8035125
J Laryngol Otol. 1994 May;108(5):423-5.

Internal jugular vein blowout complicating head and neck surgery.

Timon CV, Brown D, Gullane P.

Source

Department of Otolaryngology, Head and Neck Surgery, Toronto Hospital, Ontario, Canada.

Abstract

Internal jugular venous rupture after head and neck surgery is a rare but important condition to recognize. The Toronto General Hospital experience of this condition, together with its identification and management is reported. Jugular vein rupture should be considered in patients undergoing primary tumour excision with modified or functional neck dissection complicated by a pharyngo-cutaneous fistula. Typically, bleeding is venous and occurs repeatedly. However, haemorrhage may be substantial and life-threatening. Treatment requires exploration and ligation of the venous system. The carotid artery should be assessed and protected at surgery, since there is a likelihood of a carotid blowout as the conditions have a common aetiology. It is important to distinguish jugular vein haemorrhage from carotid arterial rupture, since the former has a far better outcome if treated properly.

This is a discussion of rupture of the IJV after head and neck surgery. I don't know if as serious a rupture could result form angioplasty or from a surgical grafting procedure. The part I don't like reading is that hemorrhage can be substantial and life-threatening, and then that treatment is ligation. It does say that a jugular vein hemorrhage has a far better outcome than a carotid hemorrhage.

Jugular vein hemorrhage has not been reported by any of the patients or doctors as a result of CCSVI angioplasty. Dissection or small tears have been treated by stenting or by suctioning out any small clot that is already forming and then following-up with a day-after ultrasound with the possibility of a second procedure if needed.
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Re: 'IJV blowout complicating head and neck surgery' article

Postby drsclafani » Sat Jul 28, 2012 6:09 pm

Cece wrote:http://www.ncbi.nlm.nih.gov/pubmed/8035125
J Laryngol Otol. 1994 May;108(5):423-5.

Internal jugular vein blowout complicating head and neck surgery.

Timon CV, Brown D, Gullane P.

Source

Department of Otolaryngology, Head and Neck Surgery, Toronto Hospital, Ontario, Canada.

Abstract

Internal jugular venous rupture after head and neck surgery is a rare but important condition to recognize. The Toronto General Hospital experience of this condition, together with its identification and management is reported. Jugular vein rupture should be considered in patients undergoing primary tumour excision with modified or functional neck dissection complicated by a pharyngo-cutaneous fistula. Typically, bleeding is venous and occurs repeatedly. However, haemorrhage may be substantial and life-threatening. Treatment requires exploration and ligation of the venous system. The carotid artery should be assessed and protected at surgery, since there is a likelihood of a carotid blowout as the conditions have a common aetiology. It is important to distinguish jugular vein haemorrhage from carotid arterial rupture, since the former has a far better outcome if treated properly.

This is a discussion of rupture of the IJV after head and neck surgery. I don't know if as serious a rupture could result form angioplasty or from a surgical grafting procedure. The part I don't like reading is that hemorrhage can be substantial and life-threatening, and then that treatment is ligation. It does say that a jugular vein hemorrhage has a far better outcome than a carotid hemorrhage.

Jugular vein hemorrhage has not been reported by any of the patients or doctors as a result of CCSVI angioplasty. Dissection or small tears have been treated by stenting or by suctioning out any small clot that is already forming and then following-up with a day-after ultrasound with the possibility of a second procedure if needed.


Blow outs require that there be a surgical incision or necrosis of the overlying skin by radiation or infection. This results in contact of the vein with the atmosphere which dries out the blood vessel. Of course veins are low pressure but high flow. Should they bleed freely without the resistance of overlying tissue, the hemorrhage can be torrential and lethal.

Angioplasty that results in perforation of a vessel does not result in exsanguination or other serious hemorrhage because the resistance of the overlying tissue is greater than the pressure of the bleeding. Arterial hemorrhage on the other hand is often of high enough pressure to exceed the ability of the tissue to contain it.
Salvatore JA Sclafani MD
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Re: 'IJV blowout complicating head and neck surgery' article

Postby Cece » Sat Jul 28, 2012 9:52 pm

Thanks, that is helpful. The resistance of the tissue is greater than the pressure of the bleeding.

I was also looking into this as a risk of venous grafting or jugular patch angioplasty, which require surgical incision.
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Re: 'IJV blowout complicating head and neck surgery' article

Postby drsclafani » Sun Jul 29, 2012 4:32 am

Cece wrote:Thanks, that is helpful. The resistance of the tissue is greater than the pressure of the bleeding.

I was also looking into this as a risk of venous grafting or jugular patch angioplasty, which require surgical incision.

I don't think that is a likely result of standard surgey. It would be quite rare
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