Complications of Central Venous Catheterisation
The pre-procedure ultrasound revealed a good calibre right internal jugular vein in the upper neck, which became slight narrower when traced to the lower angle of Sedillot's triangle; it had an irregular outline with multiple collaterals. The picture was almost same on left side.
Here was a patient with sickle-cell disease who, at age 31, had already had her jugulars and other central veins punctured many times. I believe that was the cause of the CCSVI-like stenosis at the base of both jugular veins.
Stenosis of a vein at higher level in the neck can be diagnosed easily by pre-procedure ultrasound, but lower level stenosis may falsely dilate the internal jugular vein (IJV) in the neck luring the physicians to attempt forceful central venous catheter insertion. It will be difficult or impossible to insert the guidewire/central venous catheter depending on the degree of stenosis. Even after successful central venous catheter insertion, the risk of further stenosis and complete occlusion remains high.
In CCSVI, we often have "lower level stenosis" at the juncture of the internal jugular vein and the innominate vein. Here is a statement that stenosis at a higher level can be easily diagnosed by ultrasound, but stenosis at the lower level is more difficult to diagnose. This is in keeping with the many contradictory findings of the various ultrasound studies of CCSVI. It is not easy to diagnose.