Anatomy of venous system of lower limb

venous system anatomy

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

2. Introduction The leg can be regarded as a tube consisting of powerful muscles with veins running up the centre. The direction of flow is governed by valves so that flow is from superficial to deep and from below upwards.

3. Introduction The venous drainage system of the lower extremity consists of three sets of veins: Deep veins, Superficial veins Perforating veins. All veins contain delicate one-way valves that normally open to allow blood to flow toward the heart and prevent blood from flowing in a retrograde fashion after the valves close .

4. Superficial veins The veins have thick muscular walls. The major trunks are the long & short saphenous veins. These trunks run in tunnels created by a condensation of superficial fascia.

5. The long saphenous vein T he long saphenous vein is the longest vein in the body. Begins on the dorsum of foot from medial end of dorsal venous arch. Run 1 to 1.5 inch anterior to the medial malleolus ,along the medial side of the leg , and behind knee .

6. The long saphenous vein At the ankle the position of the LSV is constant , lying in the groove b/w the anterior border of the medial malleolus and tendon of tibialis anterior. In the thigh it inclines forwards to reach the saphenous opening where it pierces the cribriform fascia and opens into the femoral vein 3-4 cm below and lateral to the pubic tubercle.

7. The long saphenous vein The saphenous nerve is closely associated with the long sapenous vein. The saphenous vein at the ankle is a common site for a ‘cut down’ in emergencies. The saphenous nerve must not be included in a ligature around the vein. In the thigh medial femoral cutaneous nerve run in close relation with vein

8. The long saphenous vein Below the knee,the great saphenous vein receives posterior arch vein (Leonardo's vein) . This collects blood from a complex of veins overlying the posteromedial aspect of the calf . And its main drainage is into the deep system via multiple veins perforating the deep fascia.

9. The long saphenous vein The posterior arch vein drain to accessory saphenous vein running parallel to the long saphenous vein. Anterior veins of leg(stocking vein) ascend across the shin and join either LSV or posterior arch vein . There is a free anastomosis b/w tributaries of short saphenous vein and venous arch connecting medial ankle perforating vein and this medial ankle perforating veins are connected with LSV in lower third of leg.

10. The long saphenous vein In the thigh before entering in the saphenous opening it recieves Anterolateral vein Posteromedial vein of thigh Superficial external pudendal vein Superficial epigastric vein Superficial circumflex iliac vein Deep External Pudendal Vein

11. The long saphenous vein Vulval varicosities may occur during pregnancy. Most cases have incompetent long saphenous veins and their superficial tributaries Other sources of such varicosities are as follows:

12. The long saphenous vein 1.some veins from the labia majora pass with the round ligament through inguinal canal. They may become varicose and cause hernia like swelling in the groin and may cause considerable swelling of the labia majora .

13. The long saphenous vein 2.Tributaries of the internal pudendal vein, when enlarged, cause swelling of the perineum, and the posterior part of the labia. These conditions may occur in the latter part of pregnancy.

14. The long saphenous vein When GSV is removed for arterial grafting, it is important to place the incision over the vein. Undermining of the skin results in skin necrosis. Because of its valves vein has to be reversed when it is used to replace or bypass an arterial obstruction. In an insitu vein graft,the valves have to be destroyed to allow arterial blood to flow down the vein.

15. The short saphenous vein It begins by the fusion of number of small veins below and behind the lateral malleolus . Here vein runs with the large sural nerve up to lower third of leg. SSV is runs upward up to the middle of the popliteal space, where it passes deep to fascia to enter into popliteal vein

16. The short saphenous vein SSV runs along the outer edge of the achilles tendon, passes to midline, continues until middle of the popliteal space & enters into popliteal vein. When SSV goes through the fascia, the posterior cutaneous nerve of thigh emerges,passes deep to superficial.

17. The short saphenous vein In the lower third of the calf it lies on the deep fascia and cover by skin and superficial fascia . In the middle third of leg it enters in the intrafascia compartment in the aponeurotic investment of the gastrocnemius muscle .

18. The short saphenous vein Upper third of leg it penetrates the deep fascia and enter popliteal space and lie b/w head of two gastrocnemius muscle which lies 1.25cm below the transvers skin crease behind knee . Here SSV join popliteal vein

19. The short saphenous vein In 90% of cases SSV perforates the investing fascia of the leg below the popliteal fossa. In such cases the vein is merely ligated in its subcutaneous position, recurrent varicosities will occur because the incompetent upper segment will be left intact.

20. The short saphenous vein Several small vessels connect the lower part of the small saphenous vein to the venous arches on the inner side of the leg. These are connected to the medial ankle perforating veins. The upper part of SSV communicates with the GSV in the posteromedial vein of the thigh.

21. Structures accompanying the SSV Sural nerve in lower third of leg Lymphatic trunk which drains lateral aspect of foot and drain in the popliteal lymph nodes

22. The deep veins This veins lie in deep fascial plane and are supported by powerful muscles of leg. These are 1: Anterior and posterior Tibial veins 2: Peroneal vein 3: Popliteal vein 4: Femoral vein These veins accompany with Arteries.

23. The deep veins Soleal veins are unvalved & empty segmentally into posterior tibial & peroneal veins. Thrombosis in the soleal sinuses may extend into the perforating veins after spontaneous recanalization, the protective valve is destroyed which allows the blood to go from deep to superficial system.

24. Perforating veins These are communicating veins b/w superficial and deep veins. Two type: 1 Indirect veins 2 Direct veins

25. Perforating veins Indirect perforating veins : These consist of small superficial veins which penetrate the deep fascia to connect with vessel in muscle and in turn end in Deep vein.

26. Perforating veins Direct perforating veins : These directly connect superficial veins with deep veins. These are long and short saphenous veins, and smaller perforating veins.

27. Perforating veins In thigh : Adductor canal perforator connects long saphenous with femoral vein in lower part of adductor canal. ( hunterian’s perforator) In the lower thigh on medial aspect Long SV connect femoral vein via DODD’s Perforator.

28. Perforating veins Below knee : Perforator connects long SV or post-Arch vein with posterior tibial vein knows as BOYD’S Perforator

29. Perforating veins In leg 1.Lateral perforator is presented at the junction of mid & lower third of leg. It connect SSV with peroneal vein.

30. Perforating veins Medially there are three perforator which connect posterior arch vein with posterior tibial vein , know as COCKETT’S Perforator

31. Perforating veins Upper medial perforator lies at the junction of middle and lower third of leg. Middle medial perforator lies 4Inch above the medial malleolus . Lower medial perforator lies posterio -inferior to the medial malleolus

32. Thank you