How reliable is carotid artery guidance for internal jugular vein cannulation?

Aim: Because of the proximity between the common carotid artery (CCA) and internal jugular vein (IJV), determination of carotid localization by palpation has an important role in central vein cannulation (CVC) using the anatomical marking method. Changes in the location of the CCA and IJV may cause complications during CVC. We aimed to demonstrate the anatomical relationship between the CCA and IJV to help reduce the possibility of complications during IJV cannulations by using the anatomical landmarks. Material and Methods: Images of 79 adult patients who underwent neck CT angiography were retrospectively analyzed from the hospital database. Anatomical relationships, tissue depth and diameters of CCA and IJV were measured and then analyzed from three anatomical segments (second tracheal ring, cricoid cartilage, and superior border of the thyroid cartilage) determined on CT. Results: A total of 158 IJVs and CCAs from 79 subjects were analyzed. As anticipated, in the majority of cases, the IJV was found lateral to the CCA. (101 out of 158, or 64%). However, in a significant portion of cases (57 out of 158, or 36%), the IJV was not found lateral to the CCA. The location of the IJV relative to the CCA was observed as follows: in 31 cases (20%), it was located anterolaterally; in 19 cases (12%), it was located posterolaterally; and in 7 cases (4%), it was situated directly anteriorly, causing complete overlap. Conclusion: Variations in the anatomical relationship of the IJV and CCA are not uncommon. Therefore, anatomical landmark-guided cannulation with only CCA palpation may not always provide accurate anatomical guidance. If the first attempt at IJV cannulation with CCA palpation is unsuccessful, anatomical variation should be considered, and instead of repeating attempts, we believe it would be more accurate to proceed with imaging-guided procedures. [Turk J Vasc Surg 2025; 34(1.000): 47-51]