Background and Goal of Study: 
The presence of thrombi or complete thrombosis of the internal jugular vein (IJV) may be a cause of failure of venous catheterization. IJV thrombosis is a rare and an underdiagnosed condition. Its most frequent causes are: previous central venous catheterization, head and neck trauma, infection or surgery, malign diseases, other hypercoagulable states and intravenous drug abuse. It may also occur spontaneously. The goal of this study was to determine the incidence of IJV thrombosis (or presence of thrombi) in patients scheduled for cardiac surgery before central venous catheterization.

Materials and Methods:  
73 patients scheduled for cardiac surgery were included and a total of 146 IJV were explored. A trained anaesthesiologist performed an echo-Doppler of both IJV from the submandibular area to the supraclavicular fossa before venous catheterisation. All the known risk factors for IJV thrombosis were recorded. Exclusion criteria were patients with a jugular catheter in place before surgery. 
Results and Discussion: The incidence of thrombi in our sample was 2, 73%. The incidence was exactly the same in the left than in the right side. Large venous valves were observed in 19, 2%  of the cases in the right side and in 11% in the left side. None of the classic known risk factors was associated with a higher incidence of thrombi in our sample. The use of anticoagulant or antiplatelet therapy was not protective.  

Conclusion: 
There is compelling evidence that ultrasound guided internal jugular vein catheterisation is associated with a higher success rate an fewer mechanical complications compared with traditional approach based on external anatomical landmarks. But availability of ultrasound machine in the intraoperative setting might be a problem, especially because of the realisation of simultaneous procedures in a short period of time that may require ultrasound use. Due to the incidence of IJV thrombosis and large venous valves, at least, the screening of the internal jugular veins before puncture may help to choose the right vein to catheterise avoiding failure in catheterisation and its potential complications and saving time in the intraoperative setting. We should discuss also the need of malignancy research in those cases of finding of an IJV thrombosis without apparent cause.

Detection of internal jugular vein thrombosis in cardiac surgery