Human Anatomy, Part 2 - K. A. Dyubenko, A. K. Kolomiyytsev, Yu. B. Chaykovsky 2008

Special Part
Cardiovascular system, systema cardiovasculare – Venous system
Veins of the systemic circulation – Superior vena cava system – Veins of the upper limb

The Veins OF THE upper limb are divided into superficial and deep ones. The superficial veins are located in the subcutaneous tissue and accompany the cutaneous nerves, whereas the deep veins are situated mainly between Muscles and accompany Arteries. Superficial and deep veins anastomose with each other, possess Valves, and form extensive venous networks. All veins of the upper limb drain into the major venous trunk, the axillary vein, v. axillaris (Fig. 70).

The superficial veins of the upper limb, vv. superficiales membri superiores (Fig. 71), are numerous and form an anastomotic venous network on the dorsal surface of the hand, rete venosum dorsale manus (Fig. 71 A). At the level of the Metacarpal bones, dorsal metacarpal veins, vv. metacarpales dorsales, arise from the network on the DORSAL SIDE OF the fingers. The dorsal metacarpal vein of the first digit is termed the v. cephalica pollicis. It receives the metacarpal vein of the second digit, as well as the metacarpal vein of the second intercostal space, and continues onto the forearm as the v. cephalica. The dorsal metacarpal veins of the third and fourth intercostal spaces unite to form the so-called v. salvatella (salutary vein), which continues onto the forearm as the medial basilic vein of the arm, v. basilica.

* Oleksiy Mykolayovych Maksymenkov (1906–1968) was a renowned topographic anatomist and HEAD of the Department of Operative Surgery and Topographic Anatomy at the Military Medical Academy.

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Fig. 68. Jugular veins, venae jugulares. A – anterior view. B – lateral view (after O. M. Maksymenkov).

Fig. 69. Jugular veins, venae jugulares (Variants of jugular vein Structure).

A – trunk type. B – reticular type (after O. M. Maksymenkov).

The veins of the palmar surface of the hand channel venous Blood via anastomoses into the dorsal venous network of the hand, which extends into the forearm. The superficial veins of the forearm continue onto the arm. The primary among them are the lateral superficial vein, v. cephalica, and the medial superficial vein, v. basilica.

The lateral superficial vein of the arm, v. cephalica*, lies beneath the Skin of the arm (Fig. 71). It originates from the Branches of the dorsal venous network of the hand on the radial side. Initially, the vein courses along the radial border of the forearm, then shifts to its anterior surface, where it anastomoses in the region of the cubital fossa via the vena intermedia cubiti with the medial superficial vein of the arm. In the arm, the v. cephalica runs within the lateral bicipital sulcus (sulcus bicipitalis lateralis), then enters the deltopectoral groove (sulcus deltoideopectoralis), pierces the fascia, and empties into the axillary vein, v. axillaris.

The medial superficial vein of the arm, v. basilica**, is the largest vein of the upper limb (Fig. 71). It arises from the venous network on the ulnar side of the hand. Initially, it courses along the dorsal surface of the forearm, then shifts to its anterior surface, reaching the arm along its medial border. Here, it lies within the medial bicipital sulcus (sulcus bicipitalis medialis). In the middle third of the arm, the v. basilica pierces the fascia and empties into one of the brachial veins.

The intermediate vein of the elbow, v. intermedia cubiti (Fig. 72), in 75% of cases represents a veno-venous anastomosis that connects the v. basilica and v. cephalica in the region of the cubital fossa and anastomoses with the deep veins. The intermediate vein of the elbow exhibits several anastomotic variants resembling the outlines of letters: N-shaped (42%), Y-shaped (33%, represented as И in Ukrainian), H-shaped (1%) (B. B. Ihnyev, V. Kh. Frauchy). In clinical practice, it serves as a site for administering medicinal solutions, blood transfusions, and blood substitutes, as well as for drawing blood for laboratory testing.

The deep veins of the upper limb, vv. profundae membri superiores, predominantly accompany arteries in pairs, thus forming venae comitantes (satellite veins). The primary among them are the brachial veins, vv. brachiales, radial veins, vv. radiales, ulnar veins, vv. ulnares, and interosseous veins, vv. interosseae.

In the hand, corresponding to the arterial arches, lie venous arches: the superficial palmar venous arch, arcus venosus palmaris superficialis, and the deep palmar venous arch, arcus venosus palmaris profundus. The venous arches continue into the ulnar and radial veins, which accompany the corresponding arteries and empty into the brachial veins, vv. brachiales. The brachial veins unite at the level of the lower border of the pectoralis major Muscle to form the axillary vein, v. axillaris.

The axillary vein, v. axillaris (Fig. 70), is formed by the union of two brachial veins accompanying the brachial artery (a. brachialis). The trunk of the axillary vein runs in the axillary fossa anterior to the axillary artery (a. axillaris) up to the first rib. The axillary vein is surrounded by loose adipose tissue and Lymph Nodes. The vein exits the axillary fossa through the superior aperture formed by the first rib, the acromion, and the clavicle, and continues in the infraclavicular region as the subclavian vein, v. subclavia. Along its course, it receives the following tributaries:

1. Lateral thoracic vein, v. thoracica lateralis;

2. Thoracoepigastric veins, vv. thoracoepigastricae, which anastomose with the umbilical veins, vv. umbilicales, the inferior epigastric vein, v. epigastrica inferior, and the superficial epigastric vein, v. epigastrica superficialis.

* The main vein (v. cephalica) received its name because, during bloodletting (phlebotomy), blood was observed to flow away from the head (cephalus).

** The royal vein (v. basilica); in ancient times, it was incised during Disorders of the Liver, which was considered the primary organ.

Fig. 70. Veins of the shoulder girdle and arm.

Fig. 71. Superficial veins of the right arm (internal surface) (after Toldt).

Fig. 71 A. Superficial veins of the forearm and hand (dorsal surface) (after Toldt).

Fig. 72. Superficial veins of the upper limb and Variants of the median cubital vein (after Toldt)

Fig. 73. INFERIOR VENA CAVA, v.cava inferior, and its tributaries

Valves in the veins of the upper limb

The number of valves in the veins of the upper limb varies and depends on the Structural Features of the venous System of the limbs as a whole. Valves are distributed unevenly across different segments of the limb, with their number increasing in the upper part of the forearm and the upper third of the arm.

With a reticular STRUCTURE OF THE upper limb veins, where the independence of major venous trunks is lost due to a high density of anastomoses, valves are absent in the superficial and palmar arches, but they do occur in vv.interossea volares at their junction with the arcus venosus volaris profundus. On the dorsal aspect of the hand, valves are more numerous, spaced at intervals of 2–2.5 cm. Digital veins lack valves. In the veins of the forearm—both superficial and deep—with a reticular pattern, the number of valves is increased, with the distance between them being 1.5–2 cm. In the arm, the distance between valves is 3–4 cm, whereas in the upper half of the arm, the v.cephalica corresponding to the deltopectoral groove contains 3–4, and occasionally 5, valves.

When the main venous trunks run separately, the number of valves is half that seen in the reticular pattern, and the distance between valves in the forearm is greater (O. M. Maksymenkov).