The internal jugular veins outflow with varying degrees of internal carotid arteries stenosis using ultrasound assessment
AbstractBackground. In the progression of atherosclerotic lesions of the brachiocephalic arteries, disturbances occur interdependently in the venous system, its extra- and intracranial sections. Therefore, an adequate assessment of the venous component of cerebral hemodynamics should be an important addition to the study of the arterial bed. The most common diagnostic method for detecting pathological changes in cerebral vessels today is ultrasound. However, there is still not enough information about which parameters clinically most valuable reflect venous remodeling and outflow disturbance. Changes in the structural and functional parameters of the internal jugular veins with varying degrees of stenosis of the carotid arteries were studied in fragments.
Aim. To study the venous outflow through the internal jugular veins at different degrees of the internal carotid arteries stenosis.
Material and methods. The study included 91 patients who underwent ultrasound examination of the carotid arteries and internal jugular veins. According to the ultrasound results, patients were initially divided into three groups: group 1 (main) – 26 patients with hemodynamically significant stenosis of the internal carotid arteries of 70% or more by area (stenosis of «high» degree), group 2 (comparison) – 31 patients with stenosis of the ICA 50–60%, which we defined as «borderline», group 3 (control) – 34 patients with stenosis of the ICA less than 30% («small» stenoses). In 9 patients, a comprehensive MR-tomographic and MR-angiographic examination of the brain was performed.
Results. In the group with «high» degree stenoses, the venous peripheral and central venous pressure were statistically significantly lower, the area of the internal jugular vein were larger, and the linear velocity and volumetric flow rate on the side of the stenosis were higher than in the groups with «borderline» and «small» stenoses. The indicators in the group of «borderline» stenoses were statistically significantly different from the group with «high» degree stenosis and did not differ from the indicators of the control group, the division of this group into two subgroups: with stenoses up to 55% and more than 55% showed a statistically significant difference in linear velocity and volumetric flow rate as between subgroups and between the subgroup with stenoses greater than 55% and the control group.
Conclusion. Evaluation of the geometric and hemodynamic parameters of the internal jugular veins during a comprehensive ultrasound examination in patients with various degrees of stenosis allows clarifying the hemodynamic significance of stenotic lesions of the internal carotid arteries and then confirming the significant nature of the stenosis on MRA. Quantitative assessment of venous blood flow should be included in the complex ultrasound examination in patients with carotid atherosclerosis.
Funding. The study had no financial support.
Conflict of interest. The authors declare no conflicts of interest.
Author’s contribution. Study conception and design – Bukhovets I.L.; data collection and handling – Bukhovets I.L., Kuznetsov M.S., Maksimova A.S.; statistical processing – Maksimova A.S.; draft manuscript preparation – Bukhovets I.L., Ussov W.Yu., Maksimova A.S.; manuscript revision – Bukhovets I.L., Zavadovsky K.V., Kozlov B.N., Ussov W.Yu., Stepanov I.V.
For citation: Bukhovets I.L., Maksimova A.S., Kuznetsov M.S., Kozlov B.N., Stepanov I.V., Zavadovsky K.V., Ussov W.Yu. The internal jugular veins outflow with varying degrees of internal carotid arteries stenosis using ultrasound assessment. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 15–23. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-15-23 (in Russian)
Keywords:carotid atherosclerosis; ultrasound diagnostics; carotid endarterectomy
References
1. Ivanov A.Yu., Panuntsev V.S., Kondratiev A.N., et al. To the question of some mechanisms of the physiology of venous outflow through the veins of the neck. Clinical physiology of blood circulation. 2009; 3: 16–21. (in Russian)
2. Fedin A.I. Venous encephalopathy. Therapy. 2020; 3: 137–148. DOI: https://doi.org/10.18565/therapy.2020.3.137-148 (in Russian)
3. Dudko V.A., Karpov R.S. Atherosclerosis of the vessels of the heart and brain. 2013; Tomsk: STT. 416. (in Russian)
4. Djibladze D.N., Krasnikov A.V., Lagoda O.V., Barkhatov D.Yu. Asymptomatic stenosis of the arteries of the carotid basin. Nervous Diseases. 2005; 2: 26–31. (in Russian)
5. Suslina Z.A., Chechetkin A.O., Kuntsevich G.I., Krotenkova M.V. Algorithm of application of carotid artery angiovisualization methods. Nervous Diseases. 2013; 1: 6–9. (in Russian)
6. Kulikov V. P., Dichul M.L., Zasorin S.V., et al. Clinical pathophysiology of cerebral circulation disorders: new methods of diagnosis, prevention and treatment. Problems of Clinical Medicine. 2014; 3–4 (34): 40–54. (in Russian)
7. Kuimov A.D., Chelysheva L.V. Cerebral venous discirculation in patients with arterial hypertension associated with atherosclerosis. Ateroscleroz. 2012; 8 (2): 27–31. (in Russian)
8. Shumilina M.V., Gorbunova U.V. Complex ultrasound diagnostics of venous outflow disorders. Clinical Physiology of Blood Circulation. 2009; 3: 8–12. (in Russian)
9. Shumilina M.V. Features of ultrasound diagnostics of brachiocephalic artery pathology in the Bakoulev Center. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2021; 22 (2): 184–194. DOI: https://doi.org/10.24022/1810-0694-2021-22-2-184-194 (in Russian)
10. Tkachenko B.I., Mazurkevich G.S., Tyukavin A.I., et al. Physiology of blood circulation. Physiology of the vascular system (Manual of Physiology). 1984; Leningrad: The science. 652. (in Russian)
11. Babiyants A.Ya., Khananashvili Ya.V. Cerebral circulation: physiological aspects and modern research methods. Journal of Fundamental Medicine and Biology. 2018; 3: 46–54. (in Russian)
12. Mantovani G., Scerrati A. The cerebral venous system: new pathophysiological theories and diseases related to veins occlusion. Cerebral Circulation. 2022; DOI: https://doi.org/10.5772/intechopen.102351
13. Lelyuk V.G., Lelyuk S.E. Ultrasound angiology. 2003; Moscow: Real Time. 324. (in Russian)
14. Bukhovets I.L., Maksimova A.S., Plotnikov M.P., et al. Ultrasonographic control of cerebral blood flow in patients with stenosis of brachiocephalic arteries before and after carotid endarterectomy. Angiology and Vascular Surgery. 2018; 24 (1): 66–71. (in Russian)
15. Shumilina M.V. Venous circulation disturbances in patients with cardiovascular pathology. Clinical Physiology of Blood Circulation. 2013; 3: 5–16. (in Russian)
16. Lavrikova M.A., Zhmerenetsky K.V., Rud S.S. The state of arterial and venous blood flow in patients with atherosclerotic vascular lesion of the brachiocephalic basin and dynamics after carotid endarterectomy. Clinical Physiology of Blood Circulation. 2018; 15 (1): 11–16. (in Russian)
17. Hauser R. Venous insufficiency – Chronic Cerebrospinai Venous insufficiency and neurologic-like problems. 2021; Online resource: https://www.caringmedical.com/prolotherapy-news/chronic-cerebrospinal-venous-insufficiency.
18. Wisniewski A., Ksiazkiewicz B., Wisnievska A. The role of chronic venous insufficiency in the pathogenesis of brain diseases. Polski Merkuriusz Lekarski. 2013; 35 (208): 226–229.
19. Nakase H. Introduction: venous brain circulation disorders. Neurosurgical Focus. 2009; 27 (5): E1. DOI: https://doi.org/10.3171/2009.9.focus.nov09.intro
20. Pappadà G., Cesana C., Pirovano M., et al. Venous outflow as a criterion of impairment of cerebral vascular reserve. Journal of Neurosurgical Sciences. 2009; 53 (3): 101–105.
21. Podgórski M., Winnicka M., Polguj M., et al. Does the internal jugular vein affect the elasticity of the common carotid artery? Cardiovascular Ultrasound. 2016; 14 (1): 40. DOI: https://doi.org/10.1186/s12947-016-0084-1
22. Dias N.V., Kölbel T., Gonçalves I., et al. Hemodynamics and jugular venous oxygen saturation during carotid endarterectomy: a comparison between general and locoregional anesthesia. International Angiology. 2010; 29 (3): 232–238.
23. Vasiliev I.A., Stupak V.V., Chernykh V.A., et al. Pathogenetic aspects of impaired venous circulation of the brain. International Journal of Applied and Fundamental Research. 2014; 9 (3): 23–26. DOI: https://doi.org/10.17116/jnevro202012005137 (in Russian)
24. Bergen T.A., Trufanov G.E., Alexandrova S.A., et al. Expert consensus of the national medical research centers on the profile of “cardiovascular surgery” and the Russian Society of Radiologists and Radiologists: principles and technology of using methods of radiation diagnostics in pathology of brachiocephalic vessels. Translational Medicine. 2022; 9 (5): 5–19. DOI: https://doi.org/10.18705/10.18705/2311-4495-2022-9-5-5-19 (in Russian)
25. Litvitskiy P.F. Regional blood flow and microcirculation disorders. Regional blood circulation and microcirculation. 2020; 19 (1): 82–92. DOI: https://doi.org/10.24884/1682-6655-2020-19-1-82-92 (in Russian)
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