Jugular venous reconstruction: a technique to minimize morbidity of bilateral radical neck dissection

Abstract

Disfiguring facial edema and elevated intracranial pressure often accompany ligation and excision of the internal jugular veins (IJV) during simultaneous or staged bilateral radical neck dissection. To minimize this morbidity, unilateral reconstruction of the IJV was undertaken at the time of second-side neck dissection in 11 patients. Five patients underwent reconstruction with the spiraled saphenous vein (SVG) and in six patients 10 mm externally supported polytetrafluoroethylene (e-PTFE) was used. Prebypass jugular venous stump pressures (JVPs) were measured and ranged from 28/17 to 75/54 mm Hg with mean pressures of 17 to 62 mm Hg. Two patients had simultaneous neck dissections and nine had staged dissections. The staged interval ranged from 0.3 to 33 months. Six of nine staged reconstructions were right-sided and three of nine were left-sided. Low molecular weight dextran was started intraoperatively, regional heparinization was used in all but two cases, and platelet inhibitors were continued postoperatively in all patients. Additional time in the operating room was 45 minutes (mean). All patients have been followed up 2 to 18 months postoperatively. B-mode ultrasonography, Doppler spectrum analysis, CT scan with contrast, and magnetic resonance imaging were used to assess patency. Four of five SVGs and three of six e-PTFE grafts have remained functional, which resulted in an overall patency rate of 64%. Four grafts (one SVG, three e-PTFE) failed in the immediate postoperative period. All grafts in patients who had a mean JVP greater than 30 mm Hg remained patent, whereas those in patients with lower stump pressures thrombosed.(ABSTRACT TRUNCATED AT 250 WORDS)