Anatomy of the venous system of lower limb

Anatomy of venous system of lower limb

1. Anatomy of
Venous system
of lower limb
Dr.indumathi
b

2. Introduction
OThelegcanberegardedasatube
consistingofpowerfulmuscleswith
veinsrunningupthecentre.
OThedirectionofflowisgoverned
byvalvessothatflowisfrom
superficialtodeepandfrombelow
upwards.
Introduction

3. OThevenousdrainagesystem
ofthelowerextremity
consistsofthreesetsof
veins:
ODeepveins,OSuperficialveinsO
Perforatingveins.
OAllveinscontaindelicateonewayvalvesthat
normallyopentoallowbloodtoflowtowardthe
heartandpreventbloodfromflowingina
retrogradefashionafterthevalvesclose.
Superficial
veins

4. OTheveinshave
thickmuscular
walls.
OThemajortrunks
arethelong&
shortsaphenous
veins.
OThesetrunksrun
intunnelscreated
byacondensation
ofsuperficial
fascia.

5. Thelongsaphenous
vein
OThe long
saphenousveinisthe
longestveininthe
body.OBeginson
thedorsumoffoot
frommedialend
ofdorsalvenousarch.
ORun1to1.5inch
anteriortothemedial
malleolus
,alongthemedial

6. sideoftheleg,andbehindknee
.
The long
saphenous vein
OAttheanklethe
positionoftheLSVis
constant,lyinginthe
grooveb/wtheanterior
borderofthemedial
malleolusandtendon
oftibialisanterior.
OInthe
thigh
forwardsto
it
incline
sreach
the

7. saphenousopening
thecribriform
fascia
whereit
pierces
andopensintothefemoralvein3-4cmbelow
andlateraltothepubictubercle.
The long saphenous
vein
OThesaphenousnerveisclosely
associatedwiththelongsapenousvein.

8. OThesaphenousveinattheankleis
acommonsitefora‘cutdown’ in
emergencies.
OThesaphenousnervemust
notbeincludedinaligaturearoundthe
vein.
OInthethighmedialfemoralcutaneous
nerverunincloserelationwithvein
The long saphenous
vein

9. OBelowtheknee,thegreat
saphenousveinreceives
posteriorarchvein
(Leonardo'svein).
OThiscollectsbloodfroma
complexofveinsoverlying
theposteromedialaspect
ofthecalf.
OAnditsmaindrainageis
intothedeepsystemvia
multipleveinsperforating
thedeepfascia.

10. The long saphenous
vein
OTheposteriorarchveindrainto
accessorysaphenousveinrunning
paralleltothelongsaphenousvein.
OAnteriorveinsofleg(stockingvein)
ascendacrossthe shinandjoin
eitherLSVorposteriorarchvein.
OThereisafreeanastomosisb/w
tributariesofshortsaphenousvein
andvenousarchconnectingmedial
ankleperforatingvein

11. andthismedialankleperforatingveins
areconnectedwithLSVinlowerthirdof
leg.
The long saphenous
vein
Inthethigh beforeenteringinthe
saphenousopeningitrecieves
1.Anterolateralvein
2.Posteromedialveinofthigh

12. 3.Superficialexternalpudendal
vein
4.Superficialepigastricvein
5.Superficialcircumflexiliacvein
6.DeepExternalPudendalVein

14. Thelongsaphenousvein
OVulvalvaricositiesmayoccurduring
pregnancy.
OMostcaseshaveincompetentlong
saphenousveinsandtheirsuperficial
tributaries
OOthersourcesofsuchvaricosities
areasfollows:

15. Thelongsaphenousvein
O1.someveinsfromthelabiamajora
passwiththeroundligament
throug
hinguinalcanal.
OTheymaybecomevaricoseand
causehernialikeswellinginthe
groinandmaycauseconsiderable
swellingofthelabiamajora.

16. Thelongsaphenousvein
O2.Tributariesoftheinternal
pudendalvein,whenenlarged,
causeswellingoftheperineum,
andtheposteriorpartofthelabia.
OTheseconditionsmayoccurinthe
latterpartofpregnancy.

17. Thelongsaphenousvein
OWhenGSVisremovedforarterialgrafting,
itisimportanttoplacetheincisionoverthe
vein.
OUnderminingoftheskinresultsinskin
necrosis.
OBecauseofitsvalvesveinhastobe
reversedwhenitisusedtoreplaceor
bypassanarterialobstruction.

18. OInaninsituveingraft,thevalveshavetobe
destroyedtoallowarterialbloodtoflow
downthevein.
The short
saphenous
vein
OItbeginsbythe
fusionofnumberof
small

19. veinsbelowandbehindthelateral
malleolus.Hereveinrunswiththe
largesuralnerveuptolowerthirdof
leg.OSSVisrunsupwarduptothemiddleofthe
poplitealspace,whereitpassesdeeptofascia
toenterintopoplitealvein
The short saphenous
vein

20. OSSVrunsalongthe
outeredgeofthe
achillestendon,
passestomidline,
continuesuntilmiddle
ofthepoplitealspace
&entersintopopliteal
vein.
OWhenSSVgoes
throughthefascia,the
posteriorcutaneous
nerveofthigh
emerges,passesdeep
tosuperficial.

21. Theshortsaphenousvein
OInthelowerthirdofthecalfitlieson
thedeepfasciaandcoverbyskin
andsuperficialfascia.
OInthemiddlethirdoflegitenters
intheintrafasciacompartmentin
theaponeuroticinvestmentofthe
gastrocnemiusmuscle.

22. Theshortsaphenousvein
OUpperthirdoflegitpenetratesthe
deepfasciaandenterpopliteal
spaceandlieb/w headoftwo
gastrocnemiusmusclewhichlies
1.25cmbelowthetransversskin
creasebehindknee.

23. OHereSSVjoinpoplitealvein

25. Theshortsaphenousvein
OIn90%ofcasesSSVperforatesthe
investingfasciaofthelegbelowthe
poplitealfossa.
OInsuchcasestheveinismerely
ligatedinitssubcutaneousposition,
recurrentvaricositieswilloccur
becausetheincompetentupper
segmentwillbeleftintact.

26. Theshortsaphenousvein
OSeveralsmallvesselsconnectthe
lowerpartofthesmallsaphenousvein
tothevenousarchesontheinnerside
oftheleg.
OTheseareconnectedtothemedial
ankleperforatingveins.
OTheupperpartofSSVcommunicates
withtheGSVintheposteromedialvein
ofthethigh.

27. Structures accompanying
the SSV
OSuralnerveinlower
thirdofleg
OLymphatictrunk
whichdrainslateral
aspectoffootand
draininthepopliteal
lymphnodes

28. Thedeepveins
OThisveinslieindeep
fascialplaneandare
supportedbypowerful
musclesofleg.
OTheseare
1:Anteriorandposterior
Tibialveins
2:Peronealvein
3:Poplitealvein
4:Femoralvein

29. Theseveinsaccompanywith
Arteries.

31. Thedeepveins
OSolealveinsareunvalved
&emptysegmentallyinto
posteriortibial&peroneal
veins.
OThrombosisinthesoleal
sinusesmayextendinto
theperforatingveinsafter
spontaneousrecanalization,
theprotectivevalveis
destroyedwhichallowsthe
bloodtogofromdeepto
superficialsystem.

32. Perforatingveins
OThesearecommunicatingveinsb/w
superficialanddeepveins.
OTwotype:
1Indirectveins
2Directveins
Perforating veins

33. 1.Indirect
perforatingveins:
OTheseconsistof
smallsuperficial
veinswhich
penetratethe
deepfasciato
connectwith
vesselinmuscle
andinturnendin
Deepvein.
Perforatin
g

34. veins
ODirectperforating
veins:
OThesedirectly
connectsuperficial
veinswithdeep
veins.
OThesearelong
and short
saphenousveins,
and smaller
perforatingveins.
Perforatin
g

35. veins
OInthigh:
Adductorcanal
perforator
connectslong
saphenouswith
femoralveinin
lowerpartof
adductorcanal.
(hunterian’s
perforator)

36. OInthelowerthighonmedialaspectLong
SVconnectfemoralveinvia
DODD’sPerforator.
Perforating
veins
OBelowknee:Perforatorconnects
longSVorpost-Arch

37. veinwithposteriortibialveinknowsas
BOYD’SPerforator
Perforatingveins
OInleg
O
perforato
r
presente
djunction
1.Latera
l
isatthe
ofmid&
lowerthirdofleg.O
It

38. connectSSVwithperoneal
vein.
Perforating
veins
OMediallythere
arethree
perforatorwhich
connectposterior
archvein

39. withposteriortibialvein,knowas
COCKETT’SPerforator
Perforating veins
OUppermedialperforatorliesatthe
junctionofmiddleandlowerthirdofleg.
OMiddlemedialperforatorlies4Inch
abovethemedialmalleolus.

40. OLowermedialperforatorlies
posterioinferiortothemedialmalleolus

42. OThank
you