Surgical treatment of jugular vein phlebectasia in children
Li Jianhong1, Jiang Xuewu, Hu Tingze
1Department of Pediatric Surgery, Second University Hospital of Shantou University Medical College, Dongxia Bei Rd., Shantou City, Guangdong Province, People's Republic of China, 515041. Lijh2925@163.com
Insights
Jugular vein phlebectasia (JVP) is diagnosed using ultrasound or color Doppler flow imaging with the Valsalva maneuver. Surgical intervention is recommended for cosmetic reasons, with ligation or venoplasty being effective treatments.
Area of Science:
- Vascular Surgery
- Pediatric Surgery
- Diagnostic Imaging
Background:
- Jugular vein phlebectasia (JVP) is a rare cervical mass typically presenting as a neck swelling in children during straining.
- It is often misdiagnosed or inadequately managed, necessitating clear diagnostic and treatment guidelines.
Purpose of the Study:
- To elucidate the clinical presentation, diagnosis, and treatment of jugular vein phlebectasia (JVP).
- To recommend optimal diagnostic methods and treatment choices for JVP.
Main Methods:
- Retrospective review of 51 JVP cases, focusing on clinical presentation and diagnostic imaging.
- Evaluation of surgical interventions including ligation and venoplasty, alongside conservative management.
Main Results:
- Ultrasound or Color Doppler Flow Imaging (CDFI) combined with the Valsalva maneuver confirmed JVP in most cases.
- Surgical ligation was effective for most patients; venoplasty with encapsulation was preferred for right or bilateral internal jugular vein lesions.
- Most surgical outcomes were uneventful, with a few exceptions after right internal jugular vein ligation.
Conclusions:
- The Valsalva maneuver is crucial for JVP diagnosis, with ultrasound/CDFI as the preferred diagnostic tool due to safety and cost-effectiveness.
- Surgical intervention is recommended for cosmetic and psychological benefits.
- Ligation or venoplasty are safe and effective; venoplasty may be safer for specific internal jugular vein involvements.
Background:
Jugular vein phlebectasia (JVP) is a cervical mass that occurs relatively infrequently and usually presents in children as a soft cystic swelling in the neck during straining. It is liable to be misdiagnosed or managed inappropriately. This report elucidates the clinical presentation, diagnosis, treatment choices, and postoperative complications of JVP, and diagnostic methods and treatment choices are recommended.
Methods:
Fifty-one cases of JVP were reviewed (right vein in 38 patients, left in 7 patients, and bilateral in 6 patients). The internal jugular vein was involved the most frequently. The main complaint was a soft and compressible mass in the neck, becoming more prominent with the Valsalva maneuver. All of the children except 2 had an ultrasound or color Doppler flow imaging (CDFI) performed in combination with the Valsalva's breathing test. Surgical intervention was performed in 46 patients and the other 5 patients were followed-up conservatively for 2 to 15 years.
Results:
Ultrasound or CDFI showed local dilatation of unilateral or bilateral veins in all patients except 2, and confirmed the diagnosis in combination with the Valsalva's breathing test. Surgical intervention included ligation of the involved jugular vein in 32 patients, and longitudinal constriction suture venoplasty plus encapsulation with medical Dacron cloth or PTFE in 14 patients. All of the children who had surgery recovered uneventfully, except 3 patients undergoing ligation of the right internal jugular vein.
Conclusions:
The Valsalva maneuver was most important for establishing the diagnosis. Ultrasound or CDFI, or in combination with the Valsalva's breathing test, was the diagnostic procedure of choice to confirm the diagnosis of JVP because of its clarity, safety, and low cost. Surgical intervention was recommended for cosmetic and psychologic purposes. Ligation or excision of the involved jugular vein was very safe, simple, and effective for most patients. However, in cases of lesions of the right and bilateral internal jugular veins, longitudinal constriction suture venoplasty plus encapsulation might be more preferable and safer, and should be recommended. Otherwise, treatment should be conservative (follow-up evaluation).
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