Anatomy of the Vessels and Nerves of the Trunk (Angioneurology) - Chornokulskyi S. T. 2011

Veins of the Systemic Circulation. Veins of the Trunk
Inferior Vena Cava

(v. cava inferior) Fig. 32

is formed at the level of the intervertebral disc between the IV and V lumbar vertebrae through the confluence of the right and left common iliac Veins. Being the largest valveless vein in The Human Body, it is located to the right of the Abdominal Aorta within the retroperitoneal space. From here, it ascends behind the ROOT of the mesentery of the Small Intestine, the horizontal part of the duodenum, and the Liver, and then enters the thoracic cavity through its own caval opening in the Diaphragm, subsequently emptying into the right atrium.

The tributaries of the INFERIOR VENA CAVA are divided into parietal and visceral groups.

Parietal tributaries:

1. Inferior phrenic veins (vv. phrenicae inferiores) — paired companion veins accompanying the inferior phrenic Arteries.

2. Lumbar veins (vv. lumbales), four on each side, follow the course of the corresponding arteries and interconnect via the ascending lumbar veins (vv. lumbales ascendentes). The latter serve as the roots of the azygos and hemiazygos veins.

3. Median sacral vein (v. sacralis mediana) sometimes empties into the common iliac vein.

Visceral tributaries:

1. Hepatic veins (vv. hepaticae), numbering 3–4, drain Blood from the liver originating from both the hepatic artery system and the portal vein. They lack extra-organ trunks and empty into the inferior vena cava where it lies within the corresponding hepatic sulcus.

2. Renal veins (vv. renales): the left (longer) and right veins lie anterior to the corresponding arteries as Components of the renal pedicles (VAP — vein, artery, pelvis, from anterior to posterior).

The left renal vein crosses anterior to the abdominal aorta and, unlike the right one, receives the left suprarenal and left testicular/ovarian veins. The renal veins empty into the inferior vena cava at the level of the intervertebral disc between the I and II lumbar vertebrae.

3. Right suprarenal vein (v. suprarenalis dextra) drains directly into the inferior vena cava.

4. Right testicular/ovarian vein (v. testicularis/ovarica dextra) also empties into the inferior vena cava. On both sides, however, these veins form pampiniform plexuses (plexus pampiniformes) that entwine the respective arteries within the Spermatic Cord or the broad ligament of the Uterus, while accompanying these arteries as satellites in the retroperitoneal space. The Specific features of venous drainage on the left side (into the left renal vein opposite the entry point of the left suprarenal vein) provide an anatomical predisposition for Varicocele of the spermatic cord as well as congestive adnexitis, predominantly on this side.

HEPATIC PORTAL VEIN or portal vein of the liver

(V. portae hepatis) Fig. 34

— the largest of the visceral veins in the human body (5–6 cm in length, 1–2 cm in diameter), which collects blood from all unpaired abdominal Organs except the liver.

Roots of the hepatic portal vein:

1. Superior mesenteric vein (v. mesenterica superior);

2. Splenic vein (v. splenica, s. v. lienalis), which receives

3. Inferior mesenteric vein (v. mesenterica inferior).

The confluence of the roots of the hepatic portal vein is located posterior to the HEAD of the Pancreas. From here, the portal vein (v. portae) runs between the layers of the hepatoduodenal ligament (lig. hepatoduodenale) as part of the portal triad (DVA — ductus choledochus, v. portae hepatis, a. hepatica communis/propria) toward the porta hepatis. Here it divides into right and left branches (rr. dexter et sinister).

Tributaries of the hepatic portal vein:

1. Cystic vein (v. cystica) draining the Gallbladder;

2. Paraumbilical veins (vv. paraumbilicales) from the subcutaneous VEINS OF THE umbilical region. The roots of these veins anastomose with the superior epigastric veins (vv. epigastricae superiores) and superficial and inferior epigastric veins (vv. epigastricae superficiales et inferiores), forming a cavoportal-caval anastomosis. The paraumbilical veins course within the falciform ligament / round ligament of the liver (lig. teres hepatis), typically as multiple vessels with a significant combined diameter (up to 5–10 mm).

3. Right and left gastric veins (vv. gastricae dextra et sinistra).

V. gastrica sinistra anastomoses with the esophageal veins, forming a portosystemic (porto-caval) anastomosis.

4. Prepyloric vein (v. prepylorica).

5. Superior posterior pancreaticoduodenal vein (v. pancreaticoduodenlis superior posterior).

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Fig. 33. Vessels (3, 5, 7, 8, 9) of the posterior Mediastinum, posterior view:

1 - Trachea (trachea);

2 - right Vagus nerve (n. vagus (X) dexter);

3 - azygos vein (v.azygos);

4 - diaphragm (diaphragma);

5 - thoracic part of aorta (pars thoracica aortae);

6 - Esophagus (oesophagus);

7 - hemiazygos vein (v. hemiazygos);

8 - accessory hemiazygos vein (v. hemiazygos accessoria);

9 - Thoracic duct (ductus thoracicus);

10 - left Subclavian Artery (a.subclavia sinistra);

11 - left vagus nerve (n.vagus (X) sinister);

12 - left common carotid artery (а. carotis communis)

Fig. 34. Portal vein of the liver (see p. 64)

Fig. 34. Portal vein of the liver.

A. Roots of the portal vein and their topography.

1 - left gastric vein (B) (v. gastrica sinistra) tributary (anastomosis with esophageal veins);

2 - portal vein of the liver (A,B) (v.portaehepatis);

3 - splenic vein (A,B) (v. lienałis);

4 - pancreas (A);

5 - inferior mesenteric vein (A, B)

(v. mesenterica inferior);

6 - superior mesenteric vein (A, B)

(v. mesenterica superior);

B. Roots and tributaries of the portal vein (schematic diagram).

7 - left and right gastric veins (vv. gastricae sinistra et dextra);

8 - short gastric veins

(vv. gastricae breves);

9 - left gastro-epiploic vein

(v. gastroepiploica sinistra)

1. Superior mesenteric vein (v. mesenterica superior)

accompanies the artery of the same name within the mesentery of the small intestine, and its tributaries are veins accompanying the Arteries of the same name. These include: vv. jejunales et ileales, v. gastroomentalis dextra, vv. pancreaticae, vv. pancreaticoduodenales, v. ileocolica, v. appendicularis, v. colica dextra, and v. colica media.

2. Splenic vein (v. splenica s. v. lienalis)

drains blood from the Spleen, gastric fundus, pancreas, and greater omentum via its tributaries (which accompany the arteries of the same name):

✵ vv. gastricae breves;

✵ vv. pancreaticae;

✵ v. gastroomentalis sinistra.

The splenic vein runs along the superior border of the pancreas from the splenic hilum to the head of the pancreas, posterior to which the three roots of the v. portae hepatis unite.

3. Inferior mesenteric vein (v. mesenterica inferior)

originates as the superior rectal vein (v. rectalis superior), which is formed, in turn, by the veins of the rectal venous plexus (plexus venosus rectalis).

Tributaries:

— left colic vein (v. colica sinistra);

— sigmoid veins (vv. sigmoideae).

Fig. 35. Superficial (subcutaneous) veins of the anterolateral Regions of the trunk.

1 - direction of venous blood flow from the Head and Neck to the brachiocephalic vein (V. brachiocephalica);

2 - direction of venous blood flow to the axillary vein (v. axillaris);

3 - areolar venous plexus (plexus venosus areolaris);

4 - thoracoepigastric vein (v. thoracoepigastrica);

5 - subcutaneous veins of the umbilical region;

6 - superficial epigastric vein (v. epigasirica superficialis);

7 - superficial circumflex iliac vein (v. circumflexa ilium superficialis);

8 - external pudendal veins (w. pudendae externae);

9 - great saphenous vein (v. saphena magna);

Caval-caval anastomosis:

(4) v. thoracoepigastrica (superior v. cava system) ↔ (6) v. epigastrica superficialis (inferior V. cava system)

The inferior mesenteric vein runs retroperitoneally and drains into the splenic vein or into the confluence of all three roots of the v. portae hepatis. The rectal venous plexus provides a porto-caval anastomosis.

Veins of the pelvis (Fig. 36, 37, 38)    

These are the roots of the inferior vena cava: the right and left common iliac veins, which are formed by the merger of the internal and external iliac veins.

✵ External iliac vein (V. iliaca externa)

is the continuation of the femoral vein above the level of the inguinal ligament and receives tributaries:

✵ inferior epigastric vein (v. epigastrica inferior);

✵ deep circumflex iliac vein (v. circumflexa ilium profunda).

✵ Internal iliac vein (V. iliaca interna)

collects blood via its tributaries — paired companion veins accompanying the corresponding arteries:

— superior and inferior gluteal veins (vv. gluteae superiores et inferiores);

— obturator veins (mm. obturatoriae);

— lateral sacral veins (vv. sacrales laterales);

— vesical veins (vv. vesicates);

— uterine veins (vv. uterinae);

— deep dorsal vein of the Penis/Clitoris (v. dorsalis profunda penis/clitoridis);

— middle and inferior rectal veins (vv. rectales mediae et inferiores);

— posterior scrotal/labial veins (vv. scrotales/labiales posteriores);

— vein of the bulb of the penis/vestibule (v. bulbi penis/vestibuli).

The tributaries of the aforementioned veins are the following venous plexuses:

— Sacral Plexus (plexus venosus sacralis);

— rectal plexus (plexus venosus rectalis);

— vesical plexus (plexus venosus vesicalis);

— prostatic plexus (plexus venosus prostaticus);

— uterine plexus (plexus venosus uterinus);

— vaginal plexus (plexus venosus vaginalis).