Distended external jugular veins

Hi all. I have distended external jugular veins. My heart is ok. Could this be from my bilateral internal jugular vein compressions? Any thoughts are greatly appreciated.

I’m not sure if the external jugulars become collateral veins with the IJVs compressed, hopefully someone with more knowledge will give you the info!

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Hi @Butterfly wishes - I’m in Jules’ camp & am not sure whether the external IJVs can be responsive to internal IJV compression though it does make some sense that they could since both IJV & EJV drain into the subclavian vein.

Are you seeing a surgeon for ES yet? If not, Dr. Costantino in NYC does vascular ES surgery & has an associate who is a neurosurgeon who operates w/ him to shave C-1 if it plays a more dominant role in the compression. That might be a good team for you to see.


Thank you @Jules and @Isaiah_40_31! My left side EJV distention is more significant and my IJV “completely disappears at styloid/C1”. My right EJV is less distended and my IJV is 70% compressed styloid/C1. I’m definitely intrigued.

Yes, I saw Dr. Hepworth and have a following up in a few months. Thank you, I wasn’t sure who would be good for C1 shave. I was wondering about my C1 role but I also have C0/C1/C2 instability and concerned C1 shave could make instability worse? Still learning!

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I don’t think there’s any research about that, but there have been some discussions about instability & C1 shave, if you have time you could do a search of the past discussions & see others’ experiences…


@ButterflyWishes - Regarding your CCI & a C-1 shave, @GCD recently addressed that as he is scheduled for surgery w/ Dr. Costantino & Dr. Lo for ES surgery w/ C-1 shave. It makes sense to me that shaving C-1 could cause further cervical instability, however, what I didn’t consider is that the spine, from top to bottom, is surrounded by muscle & other connective tissues which help to stabilize it. Based on this he believes the tiny amount that’s removed to make space for the IJV won’t create or increase neck instability. I agree w/ his premise w/ this caveat - every human body is different & responds differently to stresses put upon it so what has positive, healing effect for one person may not do as well for another. Medicine is called a “practice” for a reason. Doctors are constantly learning what works for the majority but there are always exceptions. That’s what makes it such a challenge.

I vaguely remember reading on this forum someone mentioning having their IJV “repositioned” by Dr. Hepworth so a C-1 shave wasn’t necessary. It would be worthwhile asking him about that at your next appointment.


@Isaiah_40_31 Thank you for your thoughts and insight, it is really helpful. When there are so many other conditions that need to be considered it’s tough making a decision on which direction to go. I will look into Dr. Constantino and Dr. Lo and will talk with Dr. Hepworth. Thanks again.