Sonographic anatomical variations of internal jugular vein and common carotid artery relationships in a South African tertiary hospital

Abstract

Background: Internal jugular vein (IJV) cannulation is widely performed, yet complication rates remain substantial, often associated with anatomical variation. Existing evidence is predominantly derived from non-African populations and frequently lacks bilateral, multi-level assessment. A clearer understanding of IJV–common carotid artery (CCA) relationships in African patients is needed to support safer vascular access.
Aim: To characterise sonographic anatomical variations of the IJV–CCA relationship across three cervical levels and both sides of the neck in adult surgical patients.
Setting: Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
Methods: A cross-sectional ultrasound study was conducted in 178 adults. A point-of-care ultrasound (POCUS) certified investigator performed bilateral scans at the upper thyroid cartilage, cricoid cartilage and Sedillot’s triangle. Radial IJV position, vessel diameters, depth from skin, centre-to-centre distance, degree of overlap and atypical variants were recorded.
Results: Typical IJV position was consistently more frequent on the right (upper = 84.3%, middle = 70.8%, lower = 52.8%) than on the left (66.9%, 52.8%, 16.3%). Overlap > 50% occurred less often on the right at all levels (0.7% – 34.3%) compared with the left (24.2% – 67.4%). The IJV was larger on the right at all depths, while CCA depth differed significantly between sides. Atypical variants, including absence, duplication, bifurcation or valves, were rare (2.3%). Increasing age and body mass index were associated with greater overlap and deeper vessel position.
Conclusion: Marked variability exists in IJV–CCA relationships, with the right side demonstrating more favourable anatomy for cannulation.
Contribution: This study provides the first bilateral, multi-level sonographic dataset from an African cohort.