the veins of the lower limb presentation.pptx

Internal disease

1. Veins of lower limbs,types,signs and symptoms,clinical diagnosis,treatment and prevention

2. THE VEINS OF THE LOWER LIMB The veins of the lower limb can be divided into three groups: Superficial Deep Perforating .

3. The superficial veins The superficial veins consist of the great and small saphenous veins and their tributaries, which are situated beneath the skin in the superficial fascia. Having relatively thicker muscular walls. The constant position of the great saphenous vein in front of the medial malleolus should be remembered for patients requiring emergency blood transfusion.

4. The Superficial Veins The most important superficial veins are the great and small saphenous veins, which originate from the medial and lateral sides, respectively, from a dorsal venous arch in the foot. The great saphenous vein passes up the medial side of the leg, knee, and thigh to pass through saphenous opening in deep fascia covering the femoral triangle and join with the femoral vein. The small saphenous vein passes behind the distal end of the fibula (lateral malleolus ) and up the back of the leg to penetrate deep fascia and join the popliteal vein posterior to the knee.

5. The deep veins The deep veins are The venae comitantes to the anterior and posterior tibial arteries, The peroneal veins, The popliteal vein, and The femoral veins and their tributaries. Lie (deep to deep fascia) amongst & supported by powerful muscles. Deep veins generally follow the arteries. The major deep vein draining the limb is the femoral vein. It becomes the external iliac vein when it passes under the inguinal ligament to enter the abdomen.

6. Deep veins of leg Perforating veins penetrate the deep fascia, forming and continually supplying an anterior tibial vein in the anterior leg. Medial and lateral plantar veins from the plantar aspect of the foot form the posterior tibial and fibular veins. All three deep veins from the leg flow into the popliteal vein posterior to the knee, which becomes the femoral vein in the thigh. Veins accompanying the perforating arteries of the deep artery of the thigh drain blood from the thigh muscles and terminate in the deep vein of the thigh (vena profunda femoris ), which joins the terminal portion of the femoral vein.

7. The perforating veins The perforating veins are communicating vessels that run between the superficial and deep veins. Many of these veins are found particularly in the region of the ankle and the medial side of the lower part of the leg. They possess valves that are arranged to prevent the flow of blood from the deep to the superficial veins. It enables musculovenous pump to propel blood toward the heart against the pull of gravity.

8. Flow of veous blood in lower limb The direction of flow of venous blood is dictated by valves so that blood flow is from superficial to deep and from below upward. But in foot between superficial & deep.

9. LOCATION OF PERFORATORS A) An  adductor canal   perforator: It attaches the great  saphenous vein  together with the  femoral vein  in the lower part of the adductor canal. B) A knee perforator (Boyd’s perforator): It attaches the great  saphenous vein  together with the posterior tibial vein just below the knee and close to the medial border of  tibia . C) A lateral ankle perforator: It interacts the short saphenous vein together with the peroneal vein. It is situated in the junction of middle and lower third of the leg. D) Three medial ankle perforators (of Cockett ): All these are situated near the medial border of the lower third of  tibia between the medial malleolus and mid-calf and attach the great saphenous vein together with the posterior tibial veins.

10. Femoral vein The vein enters the lower angle of the femoral triangle, where it lies posterior to the artery. It ascends through the femoral triangle and comes to lie on the medial side of the artery. It receives the profunda femoris vein posteriorly and just below the femoral sheath the great saphenous vein joins it anteriorly . Within the sheath it passes under the inguinal ligament and run along the brim of the pelvis as the external iliac vein. It has four or five valves, the most constant ones being just above the junctions with the profunda and great saphenous veins. Absence of these valves could contribute to varicosity of the great saphenous vein.

11. Location of femoral vein In the living body the position of the femoral vein below the inguinal ligament is found by feeling the pulsations of the femoral artery, which is immediately lateral to the vein. In thin people the femoral vein may be surprisingly near the surface even though it is within the femoral sheath.

12. The popliteal vein The popliteal vein lies, at all levels, between the artery and the tibial nerve. It is formed by the union of the venae comitantes of the anterior and posterior tibial arteries; as it acends through the aperture in the adductor magnus it becomes the femoral vein. It receives tributaries that accompany the branches of the popliteal artery and the small saphenous vein. The popliteal vein may take the form of venae comitantes on either side of the artery.

13. The great (long) saphenous vein The great (long) saphenous vein, the longest vein in the body, begins as the upward continuation of the medial marginal vein of the foot, drains the medial end of the dorsal venous arch of the foot and passes upward directly in front of the medial malleolus . It ascends in company with the saphenous nerve in the superficial fascia over the medial side of the leg. The vein passes behind the knee and curves forward around the medial side of the thigh. It passes through the lower part of the saphenous opening in the deep fascia and joins the femoral vein about 1.5 in. (4 cm) below and lateral to the pubic tubercle. Cont.

14. The great (long) saphenous vein The great saphenous vein possesses numerous valves and is connected to the small saphenous vein by one or two branches that pass behind the knee. Several perforating veins connect the great saphenous vein with the deep veins along the medial side of the calf. Cont.

15. The great (long) saphenous vein

16. The great (long) saphenous vein At the saphenous opening in the deep fascia, the great saphenous vein usually receives three tributaries variable in size and arrangement : The superficial circumflex iliac vein, The superficial epigastric vein, and The superficial external pudendal vein. These veins correspond with the three branches of the femoral artery found in this region.

17. VALVES IN THE GREAT SAPHENOUS VEIN There are around 10 to 20 valves in the great saphenous vein, outside of which the location of 2 are important: (a) one, which is located just before it pierces the cribriform fascia (b) the other, which is located at its junction together with the femoral vein ( saphenofemoral valve). The saphenofemoral valve is of great functional importance. It is located about 3.5 to 4 cm inferolateral to the  pubic tubercle . In about 80% people, the external iliac vein possesses a valve, which shields the saphenofemoral valve against high venous pressure.

18. SURFACE MARK OF THE GREAT SAPHENOUS VEIN At ankle , it is located 2.5 cm anterior to the medial malleolus . In leg , it ascends by crossing the medial surface and medial border of the tibia. At knee , it is located about a hand’s width posterior to the medial margin of the  patella . In thigh , it ascends obliquely on the medial aspect of the thigh to reach a stage 3.5-4 cm inferolateral to the pubic tubercle ( saphenofemoral junction).

19. The small (short) saphenous vein The small (short) saphenous vein, draining the lateral side of the dorsal venous arch and the lateral margin of the foot, lies with the sural nerve behind the lateral malleolus . It passes upwards in the subcutaneous fat to the midline of the calf and pierces the deep fascia anywhere from midcalf to the roof of the popliteal fossa . It usually runs within and then beneath the deep fascia for some distance before it enters the popliteal vein. It communicates by several perforators with the great saphenous vein. The posterior femoral cutaneous nerve accompanies the upper part of the vein, while going from deep to superficial. The small saphenous vein includes 7-13 valves.

20. The small (short) saphenous vein Tributaries: Numerous small veins from the back of the leg Communicating veins with the deep veins of the foot Important anastomotic branches that run upward and medially and join the great saphenous vein. The mode of termination of the small saphenous vein is subject to variation: It may join the popliteal vein; It may join the great saphenous vein; or It may split in two, one division joining the popliteal and the other joining the great saphenous vein.

21. Venous Pump of the Lower Limb Within the closed fascial compartments of the lower limb, the thin-walled, valved venae comitantes are subjected to intermittent pressure at rest and during exercise. The pulsations of the adjacent arteries help move the blood up the limb. However, the contractions of the large muscles within the compartments during exercise compress these deeply placed veins and force the blood up the limb.

22. Varicose Veins A varicosed vein is one that has a larger diameter than normal and is elongated and tortuous. Varicosed veins have many causes: Hereditary weakness of the vein walls and incompetent valves; Elevated intra-abdominal pressure as a result of multiple pregnancies or abdominal tumors; Thrombophlebitis of the deep veins, which results in the superficial veins becoming the main venous pathway for the lower limb.

23. Varicose veins There are typical points where incompetent valves occur between the superficial and the deep veins. In these regions the varicosities tend to become marked. At the saphena varix -the saphenofemoral junction where the femoral vein is joined by the great saphenous vein. In the mid-thigh perforating vein between the great saphenous vein and the femoral vein. In the calf the three sites where perforators occur, 5, 10, and 15 cm above the medial malleolus between the great saphenous vein and the deep veins of the calf. At the junction of the small saphenous vein and the popliteal vein. A  saphena varix , or a  saphenous varix  is a dilation of the  saphenous  vein at its junction with the femoral vein in the groin.

24. Great Saphenous Vein Cutdown Exposure of the great saphenous vein through a skin incision (a cutdown ) is usually performed at the ankle . This site has the disadvantage that phlebitis (inflammation of the vein wall) is a potential complication.