Venous system anatomy perfusionist lect.pptx

venous system anatomy for M.Sc. perfusionist students

1. Venous system anatomy lecture for M.Sc. Perfusionist students Dr. Workneh T.( Asst Prof of G. surgery and cardiothoracic surgery fellow)

2. Outline Introduction Veins of head and neck Veins of upper limbs Veins of thorax Veins of abdomen Veins of lower limbs 1/22/2024 venos system anatomy 2

3. Introduction Arteries: Distribute blood to various parts Are deeply situated. Follow definite pathways. Veins: Drain blood from them. Superficial or deep. More difficult to follow connect in irregular network 1/22/2024 venos system anatomy 3

4. Cont’d… 3 systemic veins drain to the heart; Coronary sinus IVC SVC 1/22/2024 venos system anatomy 4

5. CORONARY SINUS: Main vein of heart. Located in coronary sulcus. Opens into the right atrium between the orifice of IVC and tricuspid valve. 1/22/2024 venos system anatomy 5

6. Cont’d… Recieves blood from 3 veins Great cardiac vein: ant. Interventricular sulcus joins at the left end. middle cardiac vein: (PIVS) small cardiac vein on its right end. Ant. Cardiac veins open directly into the right atrium 1/22/2024 venos system anatomy 6

7. IVC Largest vein of the body. Begins ant. To L5 by the union of CIV ascends behind the peritoneum to the right of midline pierces the caval opening of diaphragm at T8 enters inferior part of right atrium. Drains abdomen , pelvis and lower limbs. 1/22/2024 venos system anatomy 7

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9. SVC Empties blood into superior part of right atrium. Begins posteriorly to the right first costal cartilage by the union of right and left brachiocephalic veins and ends at level of 3 rd costal cartilage — enters right atrium. Drains head, neck, chest and upper limbs 1/22/2024 venos system anatomy 9

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11. Veins of head and neck: Most blood draining from the head passes into 3 pairs of veins — internal jugular, external jugular, and vertebral veins . Within the brain, all veins drain into dural venous sinuses and then into the int. jugular veins. Dural venous sinuses are endothelial lined venous channels between layers of cranial dura matter. 1/22/2024 venos system anatomy 11

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13. INTERNAL JUGULAR VEINS: from the dural venous sinuses blood flows into the internal jugular veins: Right and left internal jugular veins — pass inferiorly on either side of the neck lateral to the internal carotid and common carotid arteries. 1/22/2024 venos system anatomy 13

14. Cont’d… Unite with the subclavian veins posterior to the clavicles at the sternoclavicular joints to form the right and left brachicephalic veins. From here blood flows into the SVC. General structures drained by the internal jugular veins are the brain, face and neck. 1/22/2024 venos system anatomy 14

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16. EXTERNAL JUGULAR VEINS Right and left ext. jugular veins begin in the parotid glands near the angle of the mandible. Superficial veins that descend through the neck across the sternocleidomastoid muscles. Terminate at a point opposite the middle of the clavicles, where they empty into the subclavian veins. 1/22/2024 venos system anatomy 16

17. Cont’d… Drain structures external to the cranium, such as scalp and superficial and deep regions of the face. When venous pressure rises, during heavy coughing or straining or in cases of heart failure, the EJV become very prominent along the side of the neck. 1/22/2024 venos system anatomy 17

18. VERTEBRAL VEINS: Right and left vertebral veins originate inferior to the occipital condyles. Descend through successive transverse foramina of the first 6 cervical vertebrae and emerge from the foramina of the 6 th cervical vertebra to enter the brachiocephalic veins in the root of the neck. Drain deep structures in the neck such as the cervical vertebrae, cervical spinal cord, and prevertebral and suboccipital muscles. 1/22/2024 venos system anatomy 18

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20. Veins of the upper limbs Both superficial and deep veins return blood from the upper limbs to the heart. Superficial veins are located just deep to the skin and are often visible. Anastomose extensively with one another and with deep veins, and they don’t accompany arteries. Superficial veins are larger than deep veins and return most of the blood from the upper limbs. 1/22/2024 venos system anatomy 20

21. Cont’d… Deep veins are located deep in the body. Usually accompany arteries and have the same names as the corresponding arteries. Both have valves; more numerous in deep veins. 1/22/2024 venos system anatomy 21

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23. Superficial veins: Cephalic veins: Principal superficial veins that drain upper limbs are cephalic and basilic veins. Originate in the hand and convey blood from the smaller superficial veins into the axillary veins. Cephalic veins begin on the lateral aspect of the ‘dorsal venous arches’. (networks of veins on the dorsum of the hands formed by the ‘dorsal metacarpal veins’.) Course around the radial side of the forearms to the ant. Surface and ascend through the entire limbs. 1/22/2024 venos system anatomy 23

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25. Cont’d… End where they join the axillary veins, just inferior to the clavicles. Accessory cephalic veins originate either from a venous plexus on the dorsum of the forearms or from the medial aspects of the dorsal venous networks of the hands, and unite with cephalic veins just inferior to the elbow. Drain blood from the lateral aspect of the upper limbs. 1/22/2024 venos system anatomy 25

26. Cont’d… Basilic veins: Begin on the medial aspects of the dorsal venous arch and ascend along the posteromedial surface of the forearm and anteromedial surface of the arm. Drain blood from the medial aspects of the upper limbs. Ant. To the elbow, basilic veins are connected to the cephalic veins by the median cubital veins which drain the forearm. 1/22/2024 venos system anatomy 26

27. Cont’d… If veins must be punctured for an injection, transfusion, or removal of a blood sample, the medial cubital veins are preferred. After receiving median cubital veins, basilic veins continue ascending until they reach the middle of the arm. Penetrate the tissues deeply and run alongside the brachial arteries until they join the brachial veins. As the basilic and brachial veins merge in the axillary,area , they form the axillary veins. 1/22/2024 venos system anatomy 27

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29. Cont’d… Deep veins: 1 Radial veins: Paired radial veins begin at the deep palmar venous arches. Arches drain the palmar metacarpal veins in the palms. Drain lateral aspects of forearms and pass alongside the radial arteries. Just inferior to the elbow joint, the radial veins unite with the ulnar veins to form brachial veins. 1/22/2024 venos system anatomy 29

30. Cont’d… 2.Ulnar veins: Paired — larger than the radial veins — begin at the superficial palmar venous arches. Drain the common palmar digital veins and the proper palmar digital veins in the fingers. Ulnar veins drain the medial aspect of the forearms , pass alongside the ulnar arteries, and join with the radial veins to form the brachial veins. 1/22/2024 venos system anatomy 30

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32. Cont’d… 3. Brachial veins: Paired, accompany brachial arteries. Drain forearms, elbow joints, arms and humerus . Join with the basilic veins to form axillary veins. 4. Axillary veins: Ascend to the outer borders of the first ribs to become subclavian veins. Tributaries: correspond with branches of axillary a. Drain the arms, axillas , and superolateral chest wall. 1/22/2024 venos system anatomy 32

33. Cont’d… 5. Subclavian veins: Continuations of the axillary veins that terminate at the sternal end of the clavicles unite with the internal jugular veins to form the brachiocephalic veins. Subclavian veins drains the arms, neck, and thoracic wall. Thoracic duct of the lymphatic system delivers lymph into the junction between the left subclavian and the left internal jugular veins. Right lymphatic duct delivers lymph into the junction between right subclavian and right internal jugular veins. 1/22/2024 venos system anatomy 33

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35. Cont’d… In a procedure called ‘central line placement’, the right subclavian vein is frequently used to administer nutrients and medication and measure venous pressure. 1/22/2024 venos system anatomy 35

36. Veins of thorax: Brachiocephalic veins drain some portions of the thorax, most thoracic structures are drained by a network of veins, called the azygous system — runs on either side of the vertebral column. Azygous System consists of 3 veins — azygos , hemiazygous , and accessory hemiazygous veins. Ultimately they empty into the SVC. 1/22/2024 venos system anatomy 36

37. Cont’d… Brachiocephalic vein: Right and left brachiocephalic veins formed by the union of the subclavian and internal jugular veins drain blood from the neck, upper limbs, mammary glands, and superior thorax. BCV unite to form the SVC. 1/22/2024 venos system anatomy 37

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39. Cont’d… Azygous system: Collects blood from the thorax and the abdominal Wall. Serves as a bypass for the IVC that drains blood from the lower body. Several small veins directly link the azygous system with the IVC. If the IVC or portal system becomes obstructed, the azygous system can return blood from lower body to the SVC. 1/22/2024 venos system anatomy 39

40. Cont’d… Azygous vein: Goes ant. To the vertebral column. Slightly to the right of the midline. Begins at the junction of left ascending lumbar and right subcostal veins near the diaphragm. At the level of T4, it arches over the rt main bronchus to end in SVC. Azygous vein drains the right side of thoracic wall, thoracic viscera, and abd . Wall Receives blood from right posterior intercostal, hemiazygous , esophageal, acc. Hemiazygous , mediastinal , pericardial, and bronchial veins. 1/22/2024 venos system anatomy 40

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42. Cont’d… Hemiazygous vein: inferior Ant. Of vertebral column. Slightly to the left of the midline. Often brings at the junction of left asecending lumbar and left subcostal veins. Terminates by joining azygous vein at about the level of T9. Drains the left side of thoracic wall, thoracic viscera, and abdominal wall. Receives blood from 9 th to 11 th left post. Intercostal, esophageal and mediastinal veins. 1/22/2024 venos system anatomy 42

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44. Cot’d … Accessory hemiazygous vein: superior Left of the midline. Begins at the 4 th or 5 th intercostal space. Descends from the 5 th to 8 th thoracic vertebra or ends in the hemiazygous vein. Terminates by joining the azygous vein at about the level of the 8 th thoracic vertebra. Drains the left side of the thoracic wall. Receives blood from the 4 th to 8 th left posterior intercostal veins, left bronchial, left superior intercostal vein and mediastinal veins. 1/22/2024 venos system anatomy 44

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46. Veins of the abdomen and pelvis: Blood from the abdominal and pelvic viscera and abdominal wall returns to the heart via the IVC. IVC doesn’t receive veins directly form the GIT, spleen, pancreas, and GB. These organs pass their blood into a common vein, the hepatic portal vein, which delivers the blood to the liver. Superior mesenteric and splenic veins unite to form the hepatic portal vein. 1/22/2024 venos system anatomy 46

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48. Cont’d… Special flow of venous blood called the ‘hepatic portal circulation’. After passing through the liver for processing, blood drains into the hepatic veins, which empty into the IVC. 1/22/2024 venos system anatomy 48

49. IVC: 2 common iliac veins that drain the lower limbs, pelvis, and abdomen unite to form the IVC. Extends superiorly through the abdomen and thorax to the right atrium. 1/22/2024 venos system anatomy 49

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51. Cont’d… COMMON ILIAC VEINS: Formed by union of the internal and external iliac veins ant. to the sacroiliac joint. Represent the distal continuation of the IVC at their bifurcation. Right is shorter than left. Drain the pelvis, external genitals, and lower limbs. 1/22/2024 venos system anatomy 51

52. Cont’d… INTERNAL ILIAC VEINS: Begin near the superior portion of the greater sciatic notch and run medial to their corresponding arteries. Drain thigh, buttocks, external genitals and pelvis. Companions of the internal iliac arteries. 1/22/2024 venos system anatomy 52

53. Cont’d… EXTERNAL ILIAC VEINS: Begin at the inguinal ligaments as continuations of the femoral veins. End anterior to the sacroiliac joint where they join with the internal iliac veins to form the common iliac veins Drain lower limbs, cremaster muscle in males, and the abdominal wall. 1/22/2024 venos system anatomy 53

54. Cont’d… LUMBAR VEINS: Series of parallel veins — 4 on each side —drain blood from both sides of post. Abd . Wall, vertebral canal, spinal cord, and meninges. Run horizontally with the lumbar arteries. Connect at right angles with the right and left ascending lumbar veins — form the origin of the corresponding azygous or hemiazygous vein. Drain blood into the ascending lumbars and then run into the IVC. 1/22/2024 venos system anatomy 54

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56. Cont’d… RENAL VEINS: renal veins pass anterior to the renal arteries at the hilum Left is longer than right. Left receives left testicular vein (or ovarian vein), inferior phrenic vein, usually left suprarenal veins. Right renal vein empties into the IVC posterior to the duodenum. Drain kidneys 1/22/2024 venos system anatomy 56

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58. Veins of the lower limbs: Blood is drained from lower limbs by superficial and deep veins. Superficial veins often anastomose with one another and with deep veins along their length. Deep veins have the same names as corresponding arteries. All veins of the lower limbs have valves — which are more numerous than in veins of the upper limbs. 1/22/2024 venos system anatomy 58

59. Superficial veins: 1. Great saphenous veins: Longest veins in the body — ascend from the foot to the groin in the subcutaneous layer. Begin at the medial end of the dorsal venous arches of the foot. Dorsal venous arches are networks of veins on the dorsum of the foot formed by the dorsal digital veins Great saphenous veins pass ant. To the medial malleolus of the tibia and then along the medial aspect of the leg and thigh just deep to the skin 1/22/2024 venos system anatomy 59

60. Cont’d… Receive tributaries from superficial tissues and connect with the deep veins as well. Empty into the femoral veins at groin. Drain mainly the medial side of the leg and thigh,groin , ext. genitals and abd . Wall. Along their length, great saphenous veins have 10-20 valves more in leg than in thigh. 1/22/2024 venos system anatomy 60

61. Cont’d… These veins are more likely to be subject to varicosities because they must support a long column of blood and aren’t well supported by skeletal muscles. Can be used for prolonged administration of IVF. Important for patients who are in shock and whose veins are collapsed. 1/22/2024 venos system anatomy 61

62. Cont’d… Coronary bypass grafting — if multiple blood vessels need to be grafted, sections of great saphenous vein are used along with at least one artery as a graft. Vein grafts are reversed so that valves don’t obstruct the blood flow. 1/22/2024 venos system anatomy 62

63. Cont’d… 2. Small saphenous veins: Begin at the lateral aspect of the dorsal venous arches of the foot. Pass posterior to the lateral malleolus of the fibula and ascend deep to the skin along the posterior aspect of the leg. Empty into popliteal veins in the popliteal fossa, post. To the knee. Drain foot and posterior aspect of the leg. 1/22/2024 venos system anatomy 63

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65. Deep veins: Posterior tibial veins: Plantar digital veins unite to form the deep plantar venous arches then, Medial and lateral plantar veins Medial and lateral plantar veins, posterior to the medial malleolus of the tibia, form the paired posterior tibial veins, which sometime merge into a single vessel. Accompany the posterior tibial artery through the leg 1/22/2024 venos system anatomy 65

66. Cont’d… Ascend deep to the muscles in the posterior aspect of the leg and drain the foot and posterior compartment muscles. 2/3rds of the way up the leg, the posterior tibial veins drain blood from the fibular veins, which drain lateral and posterior leg muscles. Posterior tibial veins unite with the anterior tibial veins just inferior to the popliteal fossa to for the popliteal veins. 1/22/2024 venos system anatomy 66

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68. Cont’d… Anterior tibial veins: Paired, arise in the dorsal venous arch and accompany the ant. Tibial artery. Ascend in the interosseous membrane between the tibia and fibula and unite with the posterior tibial veins to form the popliteal vein. Drains ankle joint, knee joint, tibiofibular joint, and ant. Portion of the leg 1/22/2024 venos system anatomy 68

69. Cont’d… Popliteal veins: Formed by union of the ant. And post. Tibial veins. Also receive blood from the small saphenous veins and tributaries that correspond to branches of the popliteal artery. Drain knee joint, and the skin, muscles, bones of portions of the calf and thigh around the knee joint. 1/22/2024 venos system anatomy 69

70. Cont’d… Femoral veins: Accompany femoral arteries and are the continuation of popliteal veins just superior to the knee. Extend up the post. Surface of thighs and drains the muscles of the thigh, femurs, ext. genitals etc Just before penetrating the abd . Wall, they receive deep femoral and great saphenous veins. 1/22/2024 venos system anatomy 70

71. Cont’d.. After entering the pelvic cavity — external iliac veins. In order to take blood samples or pressures recordings from the right side of the heart, a catheter is inserted into the femoral vein as it passes through the femoral triangle . Catheter passes through the external and common iliac veins and IVC into the right atrium. 1/22/2024 venos system anatomy 71

72. Hepatic portal circulation: Carries venous blood from the GIT organs and spleen to the liver. A vein that carries blood from one capillary network to another is called a ‘ portal vein ’. Hepatic portal vein receives blood from capillaries of GIT organs and the spleen and delivers it to the sinusoids of the liver. After a meal, hepatic portal blood is rich in nutrients absorbed from the GIT. Liver stores some of them and modifies others and detoxify before they pass into the general circulation 1/22/2024 venos system anatomy 72

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74. Cont’d… Superior mesenteric and splenic veins unite to form the hepatic portal vein . SMV drains blood from the small intestine and portions of the large intestine, stomach, and pancreas through the jejunal , ileal , ileocolic , right colic, middle colic, pancreaticoduodenal , and right gastroepiploic veins. Splenic vein drains blood from the stomach, pancreas, and portions of the large intestine through short gastric, left gastroepiploic , pancreatic, and inferior mesenteric veins. 1/22/2024 venos system anatomy 74

75. Cont’d… Inferior mesenteric vein — which passes into the splenic vein, drains portions of the large intestine through the superior rectal, sigmoidal, and left colic veins. Right and left gastric veins( coronary vein ), which open directly into the hepatic portal vein, drain the stomach. Cystic vein, which also opens into the hepatic portal vein, drains the gall bladder. 1/22/2024 venos system anatomy 75

76. Cont’d… At the same time the liver is receiving nutrient rich but deoxygenated blood via the hepatic portal vein , it also is receiving oxygenated blood via the hepatic artery . Oxygenated blood mixes with the deoxygenated blood in sinusoids. Blood leaves the sinusoids of the liver through the hepatic veins, which drain into the IVC. 1/22/2024 venos system anatomy 76

77. Pulmonary circulation: Carries deoxygenated blood from the right ventricle to alveolar capillaries and returns oxygenated blood to the left atrium. Pulmonary trunk emerges from the right ventricle and passes superiorly, posteriorly, and to the left. Then divides into 2 branches: right pulmonary artery to the right lung and the left pulmonary artery to the left lung. After birth, pulmonary arteries are the only arteries that carry deoxygenated blood. 1/22/2024 venos system anatomy 77

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79. Cont’d… On entering the lungs, the branches divide and subdivide until finally they form capillaries around the air sacs within the lungs. Pulmonary capillaries unite to form venules and eventually pulmonary veins, which exit the lungs and carry the oxygenated blood to the left atrium. 2 left and 2 right pulmonary veins enter the left atrium. After birth, the pul . Veins are the only veins that carry oxygenated blood. 1/22/2024 venos system anatomy 79

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