Position and relative size of the vertebral artery according to age: Implications for internal jugular vein access.

AIM: The purpose of this retrospective observational study was to investigate the anatomical characteristics of the vertebral artery in pediatric patients using computed tomography images.

METHODS: We evaluated anatomical characteristics of the right and left vertebral artery at the cricoid level and at a lower level, which was mid-level between the cricoid cartilage and the origin of vertebral artery from the subclavian artery. At each level, the cross-sectional areas of the vertebral artery and internal jugular vein, the relative size of vertebral artery to internal jugular vein, the minimum distance between them, and the extent of overlap between them were investigated.

RESULTS: According to the chest computed tomography images of 344 patients, the sizes of internal jugular vein and vertebral artery were found to increase with age. On the other hand, the relative size of the vertebral artery to internal jugular vein was found to increase conversely with decreasing age. The distance between the vertebral artery and internal jugular vein increased with age at both sides and levels. The vertebral artery was mostly located at the medial side of the internal jugular vein, and overlapped with the internal jugular vein in at least 54% of the patients at the cricoid level and in 74% at the lower level.

CONCLUSION: The theoretical risk of vertebral artery puncture is higher in younger children during internal jugular vein catheterization.