Vena jugularis interna ve vena subclavia'nın kapaklarının özellikleri

Amaç: Vena jugularis interna ve vena subclavia, baş-boyun ve üst ekstremitelerden venöz kanın kalbe dönüşünü sağlayan major vasküler yapılardır. Genellikle kardiyak venöz kateterizasyon uygulamalarında kullanılırlar. Bu venlerin vena brachiocephalica ile birleşme yerlerinin yakınlarında kapakları bulunmaktadır. Venöz kanın perifere geri dönüşüne engel olan bu kapakların yapılacak cerrahi girişimlerde hasarlanma riskinin azaltılmasına katkıda bulunabilmek amacıyla, her iki vene ait kapakların topografık ve morfometrik özelliklerini araştırmayı planladık. Gereç ve yöntem: Bu çalışmada formalinle fikse edilmiş, belirgin vasküler patolojisi bulunmayan 8 adet erişkin erkek kadavrasında boyun disseksiyonlan yapılarak vena jugularis interna ve vena subclavia'lar tamamıyla görünür hale getirildi. Damar lümenleri longitudinal olarak açıldı. Kapaklar, morfolojik ve morfometrik olarak değerlendirildi; angulus venosus, l.kosta, articulatio sternoclavicularis ve incisura jugularis gibi referans yapılara uzaklıkları ölçülerek yerleşimleri tanımlandı. Bulgular: Vena jugularis interna'ya ait kapaklarin %75'i bicuspit, %18,75'inin unicuspit iken olguların %6,25'inde kapak bulunmadığı, vena subdavia'ya ait ka¬pakların %93,7 bicuspit, %6,2 tricuspit olduğu görüldü. Kapak derinliği vena subclavia'larda ortalama 8,9 mm (4,4-17,8 mm), vena jugularis interna'larda ortalama 6,7 mm (3,0-12,5 mm); kapağın articulatio sternoclavicularis'in alt köşesine uzaklığı, vena subclavia için ortalama 43,3 mm (20,6-54,3 mm), vena jugularis interna için ortalama 36,6 mm (28,9 mm-55,5 mm); kapağın incisura jugularis'in orta noktasına uzaklığı, vena subclavia için ortalama 73,0 mm (62,3-82,0 mm), vena jugularis interna için ortalama 51,1 mm (40,8-59,8 mm) olarak ölçüldü. Sonuç: Venöz kateterizasyonda vena jugularis interna ve vena subclavia'ya yapılacak diğer girişimlerde ven kapaklarının yaralanma riskinin en aza indirilmesi, kapakların yerleşim ve anatomik özelliklerinin bilinmesi ile mümkün olacaktır.

The valve characteristics of the internal jugular vein and subclavian vein

Objective: Intenal jugular vein and subclavian vein are the major vessels, returning the venous blood to heart from head-neck and upper extremities. Generally, they are used in cardiac venous catheterization procedures. The valves of these veins are close to the brachiocephalic vein comissure. To decrease injury risk of the valves during the surgery, that was performed to prevent the returning of venous blood to periphery, we aimed to investigate the topographic and morphometric features of valves of the both veins.Material and method: The internal jugular vein and subclavian vein were examined in eigth farmalin fixed adult cadavers without significant vascular pathology for these study. Vascular lumens were dissected longitudinally. Valves were evaluated morphologically and morphometrically; their locations were defined according to their distance with reference structures such as angulus venosus, first rib, sterno-clavicular joint and jugular notch. Results: The valve type of the internal jugular vein was bicuspid in 75% of the specimens, unicuspid in 18.75%, without valve in 6.25% and in subclavian vein were found bicuspid 93.7%, tricuspid 6.2% in the specimens . The mean (average) of valve depth was 8.9 mm (4.4 mm to 17.8 mm) in subclavian vein and 6.7 mm(3.0 mm to 12.5 mm) in internal jugular vein the distance between the valve and inferior corner of the sternoclavicular joint was 43.3 mm (20.6 mm to 54.3 mm) for subclavian vein, 39.6 mm. (28.9 mm to 55.5 mm) for internal jugular vein and the distance between the valve and midpoint of jugular notch was 73.0 mm ( 62.3 mm to 82.0 mm) for subclavian vein and 51.1 mm ( 40.8 mm to 59.8 mm) for internal jugular vein. Conclusion: Knowledge of the location and anatomic features of the valves, will minimize the risk of vein valve injury during the venous catheterization and other internal jugular vein and subclavian vein procedures.

Kaynakça

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