The jugular veins are located in the neck: they are blood vessels depleted in oxygen from the head to the heart. The jugular veins are four in number, and are therefore located in the lateral parts of the neck. There are the anterior jugular vein, the external jugular vein, the posterior jugular vein and the internal jugular vein. The term is used by Rabelais, in his book Gargantua, in 1534, under the expression of “venit jugulares“, But comes from the Latin”throatWhich designates “the place where the neck meets the shoulders”. Pathologies of jugular veins are rare: only rather exceptional cases of thrombosis have been reported. Likewise, external compressions remain very infrequent. In the event of swelling, hardening or pain felt in the neck, the differential diagnosis of thrombosis can be made, or on the contrary refuted, by means of medical imaging associated with laboratory tests. In the event of thrombosis, treatment with heparin will be initiated.

The jugular veins are located on either side of the lateral parts of the neck. Etymologically, the term comes from the Latin term throat which means “throat”, and so it is literally “the place where the neck meets the shoulders”.

The internal jugular vein

The internal jugular vein begins at the base of the skull, before descending to the collarbone. There, it then joins the subclavian vein and will thus constitute the brachiocephalic venous trunk. This internal jugular vein is located well deep in the neck, and it receives many veins in the face and neck. Several sinuses, or venous ducts, of the dura, a hard and rigid membrane surrounding the brain, contribute to the formation of this internal jugular vein.

The external jugular vein

The external jugular vein originates just behind the lower jaw, near the angle of the mandible. It then joins the base of the neck. At this level, it will then flow into the subclavian vein. This external jugular vein becomes prominent in the neck when venous pressure increases, as is the case with coughing or straining, or during cardiac arrest.

The anterior and posterior jugular veins

These are very small veins.

Eventually, the right external jugular vein and the right internal jugular vein both drain into the right subclavian vein. The left internal jugular vein and the left external jugular vein both go into the left subclavian vein. Then, the right subclavian vein joins the right brachiocephalic vein, when the left subclavian vein joins the left brachiocephalic vein, and the right and left brachiocephalic veins will eventually both come together to form the superior vena cava. This large and short superior vena cava is the one that conducts most of the deoxygenated blood from the part of the body above the diaphragm to the right atrium of the heart, also called the right atrium.

The jugular veins have the physiological function of bringing the blood from the head to the chest: thus, their role is to bring the venous blood, depleted in oxygen, back to the heart.

Internal jugular vein

More specifically, the internal jugular vein collects blood from the brain, part of the face as well as the anterior area of ​​the neck. It is rarely injured in neck trauma due to its deep location. Ultimately, it has the function of draining the brain, but also the meninges, the bones of the skull, the muscles and tissues of the face as well as the neck.

External jugular vein

As for the external jugular, it receives the blood which drains the walls of the skull, as well as the deep parts of the face, and the lateral and posterior regions of the neck. Its function consists more precisely in draining the scalp and the skin of the head and neck, the skin muscles of the face and neck as well as the oral cavity and the pharynx.

The pathologies of the jugular veins turn out to be infrequent. Thus, the risk of thrombosis is very rare and external compressions are also very exceptional. Thrombosis is the formation of clots in the blood vessels. In fact, the causes of the frequency of spontaneous jugular venous thrombosis, according to the scientist Boedeker (2004), are as follows:

• cause linked to cancer (50% of cases);
• para-infectious cause (30% of cases);
• intravenous drug addiction (10% of cases);
• pregnancy (10% of cases).

When a venous thrombosis of the jugular is suspected, it will be essential:

• initiate heparinization of the patient (an administration of heparin which helps to slow blood clotting);
• administer a broad-spectrum antibiotic.

With swelling, hardening, or pain in the neck, the clinician should consider, when making a differential diagnosis, that it may be a venous thrombosis in that area of ​​the body. It is therefore necessary to carry out in-depth investigations. And so, the clinical suspicion of acute jugular vein thrombosis should be confirmed very quickly:

• by medical imaging: MRI, scanner with contrast product or ultrasound;
• by laboratory tests: these should include D-dimers as relatively nonspecific but very sensitive markers of thrombosis, as well as markers of inflammation such as CRP and leukocytes. In addition, blood cultures must be performed in order to detect possible infections and to be able to treat them sufficiently quickly and appropriately.

In addition to consistent treatment, such venous thrombosis of the jugular veins requires the consistent search for an underlying condition. It is therefore necessary to proceed in particular to the search for a malignant tumor, which can be a cause of paraneoplastic thrombosis (that is to say generated as a result of cancer).

In the early twentieth^e century, breathed in the city of Lyon an unsuspected breeze that gave birth, then strongly progress, vascular surgery. Four pioneers by the names of Jaboulay, Carrel, Villard and Leriche thus distinguished themselves in this field, driven by the momentum of progress … Their experimental approach was promising, likely to generate feats such as vascular grafts or even transplants of ‘organs. The surgeon Mathieu Jaboulay (1860-1913) was notably a real sower of ideas: he thus created in Lyon the rudiments of vascular surgery, at a time when no attempt had yet been made. He notably invented a technique for end-to-end arterial anastomosis (communication established by surgery between two vessels), published in 1896.

Mathieu Jaboulay had also foreseen many potential applications for arteriovenous anastomosis. Proposing to send arterialized blood to the brain without carotid-jugular anastomosis, he proposed to Carrel and Morel to carry out an experimental study, in dogs, on the end-to-end anastomosis of the jugular and the primary carotid. The results of this experiment were published in 1902 in the journal Lyon Medical. Here is what Mathieu Jaboulay revealed: “It was I who asked Mr. Carrel to anastomose the carotid artery and the jugular vein in the dog. I wanted to know what could give this operation experimentally before applying it to humans, because I thought that it could be useful in cases of insufficient arterial irrigation by thrombosis giving softening, or by arrest of congenital development.«.

Carrel obtained a good result in dogs: “Three weeks after the operation, the jugular vein was beating under the skin and functioning as an artery.But, for the record, Jaboulay never attempted such an operation on humans.

To conclude, we will also keep in mind that pretty metaphors have sometimes been used by some writers around this jugular. We will not fail to quote, for example, Barrès who, in his Notebooks, writing : “The Ruhr is the jugular vein of Germany“… Poetry and science intertwined sometimes also create beautiful nuggets.