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The great veins of the neck

  • Harold Ellis
    Affiliations
    Harold Ellis CBE MCh FRCS was Professor of Surgery at Westminster Medical School until 1989. Since then he has taught anatomy, first in Cambridge and now at Guy's Hospital, London. Conflicts of interest: none declared
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      Abstract

      The great veins of the neck are of considerable importance, for example, in cannulation for a central venous line. The internal jugular vein commences as the continuation of the sigmoid sinus and emerges from the jugular foramen with the IX, X and XI cranial nerves. It terminates behind the manubrio-sternal joint by joining the subclavian vein to form the brachiocephalic vein. Its surface markings are the depression between the two heads of the sternocleidomastoid. In the neck the internal jugular vein lies in the carotid sheath with the carotid artery and the vagus nerve; the cervical sympathetic chain lies immediately behind. The subclavian vein commences as the continuation of the axillary vein at the lateral border of the first rib. It passes across the first rib superficial to scalenus anterior, which itself is crossed by the phrenic nerve. It receives a single tributary – the external jugular vein. The small subclavius muscle protects the subclavian artery from injury in fractures of the clavicle. The right brachiocephalic vein passes vertically downwards. It meets the left brachiocephalic vein behind the lateral border of the manubrium to form the superior vena cava, which passes downwards to enter the right atrium.

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