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

Special Part
Cardiovascular system, systema cardiovasculare - Venous system
Veins of the systemic circulation - Major venous anastomoses of the human body - Veins of the lower limb

The Veins OF THE lower limb, vv. mеmbrі inferioris, are subdivided into superficial (subcutaneous) and deep veins.

The superficial veins of the lower limb, vv. superficiales membri inferioris, are located within the subcutaneous adipose tissue. The superficial veins of the FOOT originate from the superficial venous plexuses of the dorsal and plantar aspects.

On the dorsal surface of the digits, along their lateral and medial margins, lie the dorsal digital veins of the foot, vv. digitales dorsales pedis. They originate from a dense venous plexus situated in the region of the terminal Phalanges. Near the Base of the digits, the vv. digitales dorsales pedis merge in pairs from the adjacent surfaces of two neighboring digits to form the common dorsal digital veins, vv. digitales communes pedis (Fig. 79).

Emptying into these are the intercapillary veins, vv. intercapitulares, which arise from the cutaneous plantar venous arch, arcus venosus plantaris cutaneus. They course through the interosseous spaces in the region of the metatarsal heads and, upon reaching the dorsum of the foot, drain into the vv. digitales dorsales pedis, thereby forming anastomoses between the plantar and dorsal veins of the foot.

The common digital veins of the foot, vv. digitales communes pedis, in the region of the distal metatarsals, form the dorsal venous arch of the foot, arcus venosus dorsalis pedis (Fig. 79). Through numerous small branches, this arch connects with the dorsal venous network of the foot, rete venosum dorsale pedis, which is located in the proximal region of the foot's dorsum.

The superficial venous network of the dorsum of the foot forms extensive anastomoses with the deep veins and proximally continues into the superficial venous network of the anterior leg. Among the numerous interconnected vessels of this network, two veins stand out due to their size and consistent Location, running along the medial and lateral margins of the foot: the lateral marginal vein, v. marginalis lateralis, and the medial marginal vein, v. marginalis medialis.

Dense subcutaneous venous networks are located within the subcutaneous tissue of the plantar surface of the digits, from which Blood drains into the subcutaneous plantar venous arch, arcus venosus plantaris. The plantar arch lies transversely in the region of the anterior border of the transverse fascicles of the plantar aponeurosis, corresponding to the Skin furrow at the base of the digits. From the arch, in each interdigital space, one or two branches arise—known as the intercapillary veins, vv. intercapitulares—which course between the metatarsal heads to the dorsum of the foot, emptying into the vv. digitales communes pedis, and occasionally into the vv. digitales pedis dorsales. The ends of the arch (medial and lateral), wrapping around the respective margins of the foot, empty into the marginal veins, vv. marginales.

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Fig. 79. Veins of the dorsal surface of the foot, vv. digitales dorsales pedis.

Fig. 80. Superficial veins of the lower limb, venae superficiales membri inferioris. A. — v. saphena magna. B. — v. saphena parva

Fig. 81. Great saphenous vein, v. saphena magna, and its tributaries

The main pathways draining venous blood from the superficial veins of the foot are the small and great saphenous veins. The superficial veins of the lower limb anastomose with the deep veins and frequently form nodular dilations following childbirth and prolonged standing, which require surgical intervention.

1. The small saphenous vein, v. saphena parva (Fig. 80), is the continuation of the lateral marginal vein of the foot. In the region of the lateral malleolus, it receives several branches from the deep veins and the plantar cutaneous venous plexus, and then courses superiorly, lying lateral to the tendon of the triceps surae Muscle. In the leg, it runs along the midline, receiving numerous small tributaries, and is accompanied by the medial sural cutaneous nerve (n. cutaneus surae medialis), with which they pass between the heads of the gastrocnemius muscle within Pirogov's interaponeurotic canal. Upon reaching the popliteal fossa, the small saphenous vein pierces the fascia, enters the popliteal fossa, and empties into the popliteal vein (v. poplitea). Throughout its course, it possesses numerous Valves.

Instances occur where within the venous plexus of the posterior aspect of the leg it is difficult to isolate a main trunk of the v. saphena parva, which in such cases may be duplicated and connected by numerous anastomoses with the v. saphena magna and the deep veins of the leg (vv. peroneae, vv. tibiales posteriores) (O. M. Maksymenkov).

In other cases, a single, relatively large vein—the v. saphena parva—runs along the midline of the leg, originating in the region of the lateral malleolus. In the upper third of the leg, it runs within its own fascia and, in the area of the popliteal fossa, empties into the popliteal vein. There are very few veins emptying into it, and the latter are mostly solitary (O. M. Maksymenkov).

2. The great saphenous vein, v. saphena magna (Fig. 81), is the continuation of the medial marginal vein of the foot. It receives A number of branches from the dorsal venous network in the region of the medial malleolus, courses superiorly, runs along the medial aspect of the upper leg and knee joint accompanied by the saphenous nerve (n. saphenus), crosses the sartorius muscle, and reaches the saphenous opening (hiatus saphenus*), where it pierces the cribriform fascia and empties into the femoral vein (v. femoralis). Throughout its course, the great saphenous vein features numerous valves and receives a series of tributaries: veins of the heel region, leg, and thigh, veins of the anterior abdominal wall, and veins of the inguinal and iliac regions. In the leg, the great and small saphenous veins anastomose with each other (O. M. Maksymenkov). Anatomical variations exist where 2 to 3 saphenous veins of the thigh, appearing as large trunks, are located (laterally and medially) parallel to the main trunk of the great saphenous vein. These are the so-called accessory saphenous veins, vv. saphenae accessoriae laterale et mediale (M. A. Tsykhomirov; Lanz - Wachsmuth; O. M. Maksymenkov).

* In the region of the saphenous opening (hiatus), the great saphenous vein may receive from 3 to 7 tributaries, the presence of which must be taken into account during the Trendelenburg (Troyanov-Trendelenburg) operation (V. V. Kupriyanov, N. V. Voscresensky, 1970).

Fig. 82. Vessels of the medial aspect of the right lower limb (after R. D. Sinelnikov)

Fig. 83. Veins and Arteries of the leg. Posterior aspect of the right leg (after R. D. Sinelnikov)

The deep veins of the lower limb, vv. profundae membri inferioris, accompany the arteries and thus share the collective name: companion veins, vv. comitantes (Fig. 82). The name of each vein corresponds to that of the artery (anterior tibial veins, vv. tibiales anteriores; posterior tibial veins, vv. tibiales posteriores; fibular (peroneal) veins, vv. peroneae). The posterior tibial veins, vv. tibiales posteriores, numbering two, accompany the corresponding artery and receive the fibular veins, vv. peroneae, and small branches. In the lower part of the popliteal fossa, the two tibial veins fuse with each other and with the anterior tibial veins to form the popliteal vein (v. poplitea).

The popliteal vein, v. poplitea, lies in the popliteal fossa alongside the popliteal artery, positioned superficial to the artery (Fig. 83). The popliteal vein anastomoses with perforating veins, vv. perforantes, and receives a number of tributaries: the small saphenous vein (v. saphena parva), genicular veins (vv. articulares genu), and veins accompanying the popliteal artery. Additionally, in some cases, the popliteal vein (v. poplitea) presents as a relatively short, large trunk alongside which run large veins connected by anastomoses to the main trunk (O. M. Maksymenkov). In such cases, the v. poplitea is bounded by venous vessels. In other instances, the v. poplitea is solitary and located lateral to the artery. Its roots—vv. tibiales posteriores, muscular branches, and vv. peroneae—appear as separate veins with very few anastomoses observed between them. The formation of the popliteal vein trunk occurs quite low (at the level of the Water/144.html">Origin of the flexor hallucis longus muscle, m. flexor hallucis longus) (O. M. Maksymenkov).

From the popliteal fossa, the v.poplitea continues into the adductor canal, where it becomes known as the femoral vein, v.femoralis.

The femoral vein, v.femoralis, is an unpaired vessel that accompanies the artery of the same name. It emerges from the adductor canal into the femoral triangle, where it lies medial to the artery (Fig. 84). Throughout its course, the femoral vein receives both deep and superficial tributaries. The deep femoral vein, v.profunda femoris, forms numerous anastomoses with the femoral vein and vv.circumflexae femoris laterales. The trunk of the femoral vein may be duplicated either entirely or in its distal thigh segment (O.M. Maksymenkov). In other cases, the femoral vein, v.femoralis, remains single throughout its course, and its roots lack mutual anastomoses. The deep femoral vein is likewise single and lacks anastomoses with the main trunk of the femoral vein (O.M. Maksymenkov).

The veins of the leg are paired, with the sole exception of the deep femoral vein, v.profunda femoris. The deep veins of the lower extremity feature numerous valves. All veins of the lower extremity drain venous blood into the femoral vein, v.femoralis. The femoral vein passes through the lacuna vasorum and, superior to the inguinal ligament within the Abdominal cavity, continues as the external iliac vein, v.iliaca externa, which merges with the internal iliac vein in the region of the sacroiliac plexus to form the common iliac vein, v.iliaca communis.

Valves of the Lower Extremity Veins

The valves are considerably more pronounced in the proximal segments of the leg and thigh—areas where the veins are subject to the direct Influence of the musculofascial apparatus and function continuously. In a reticular venous pattern of the lower extremity, characterized by the duplication of the main venous trunks, the number of valves increases. On the SOLE OF THE foot, valves are consistently present in the vv.plantares laterales et mediales, as well as in the veins of the dorsal foot. In the leg, numerous valves are found in the posterior tibial veins, where their number reaches up to 14 (see Fig. 85). In the anterior tibial veins, the valve count is lower, ranging from 8 to 10. In the v.saphena magna, with a reticular venous arrangement, the maximum number of valves reaches 18–20, whereas in the femoral vein it is 9.

Fig. 84. Femoral artery, femoral vein, and femoral nerve, a.femoralis, v.femoralis et n.femoralis

Fig. 85. Phlebogram. Numerous valves in the veins of the leg

When the main venous trunks follow a separate (stem) course and appear as single vessels, the number of valves is reduced. In these cases, the highest number of valves (8–10) is found in the posterior tibial veins. In the vv.tibiales anterioris, the valve count ranges from 4 to 6. In the v.saphena magna, under a separate course of the main venous trunks, the number of valves reaches 10–14, and in the femoral vein, 5–7 (O. M. Maksymenkov) (Fig. 86).

Fig. 86. Phlebogram. Valves of the femoral vein

Fig. 87. Diagram of prenatal Fetal Circulation (after Patten)

1 - left common carotid artery; 2 - left Subclavian Artery; 3 - ductus arteriosus; 4 - left pulmonary artery; 5 - left Pulmonary veins; 6 - bicuspid (mitral) valve; 7 - blood flow to the aorta from the left ventricle; 8 - blood flow to the pulmonary trunk orifice from the right ventricle; 9 - celiac trunk; 10 - superior mesenteric artery; 11 - Adrenal gland; 12 - Kidney; 13 - left renal artery; 14 - dorsal aorta; 15 - inferior mesenteric artery; 16 - common iliac artery; 17 - external iliac artery; 18 - internal iliac artery; 19 - superior vesical artery; 20 - Urinary Bladder; 21 - umbilical artery; 22 - urachus; 23 - umbilicus; 24 - umbilical vein; 25 - sphincter; 26 - ductus venosus in the Liver; 27 - hepatic vein; 28 - orifice of the INFERIOR VENA CAVA; 29 - Blood flow through the foramen ovale; 30 - SUPERIOR VENA CAVA; 31 - left brachiocephalic vein; 32 - right subclavian vein; 33 - right Internal jugular vein; 34 - brachiocephalic trunk; 35 - portal vein; 36 - right renal vein; 37 - inferior vena cava; 38 - intestine