Internal Jugular vein thrombosis
| Category | Details |
|---|---|
| Etiology | 1. Complications from infections, surgery, trauma, malignancy, catheter placement, certain medical conditions, intravenous drug abuse, neck massage, hypercoagulable states. 2. Specific conditions include polycythemia vera, ovarian hyperstimulation syndrome, factor V Leiden, protein C/S deficiency, anti-phospholipid syndrome, anti-thrombin III deficiency. |
| Risk Factors | 1. Catheterization (especially in end-stage renal disease for hemodialysis), 2. Oncological conditions, 3. Patient-related factors (age, BMI, ICU patients, cancer), 4. Inherited thrombophilia, 5. Personal history of venous thromboembolism, 6. Surgical manipulation, 7. Congenital anomalies, 8. Conditions like Behçet disease, effort thrombosis, and conditions associated with CCSVI treatment. |
| Diagnostic Methods | 1. Ultrasound: High sensitivity and specificity for detecting IJV thrombosis. Uses color Doppler and compression ultrasound techniques. 2. CT Venography (CTV): Useful for detecting IJV thrombosis, especially in subacute or chronic stages. 3. Magnetic Resonance Venography (MRV): Nearly 100% sensitivity and specificity for superior vena cava and jugular veins, lower in shoulder area. Effective for identifying thrombosis stages. 4. Other Non-Invasive: Jugular venous pulse assessment via ultrasound, cervical strain-gauge plethysmography, and neck photoplethysmography for future diagnostic applications. |
| Treatment | 1. Anticoagulation: Mainstay for preventing thrombus growth and facilitating recanalization. Includes vitamin K antagonists, unfractionated heparin, LMWH, thrombolytic drugs for specific cases, and direct oral anticoagulants. 2. Mechanical: Catheter directed thrombolysis/thrombo-aspiration for selected patients. 3. Preventive: Guidelines recommend against routine prophylaxis of catheter-related IJV thrombosis with anticoagulants. 4. Conservative vs. Invasive Approaches: Varies; anticoagulation is preferred over thrombolysis unless specific criteria are met. No randomized controlled trials exist to compare these interventions directly. |
| Statistical Data | 1. Catheter infection as a risk factor has high sensitivity (86%) and specificity (97%). 2. Femoral vein catheterization associated with a 25% higher frequency of lower extremity DVT compared to IJV or subclavian catheters. 3. PE rates in IJV thrombosis range from 1.6% to 22.7% in studies. 4. Autopsy studies suggest IJV thrombosis is often misdiagnosed due to mild-moderate symptomatology. 5. Sensitivity and specificity of ultrasound and color flow Doppler imaging for IJV thrombosis diagnosis are highly reliable. 6. Anticoagulation treatment outcomes: lower risk of major hemorrhage, thrombotic complications, and death with LMWH; dabigatran etexilate showed safety and efficacy in recent RCT. |