Author: Charlotte O'Leary BSc, MBChB•Reviewer: Dimitrios Mytilinaios MD, PhDLast reviewed: September 23, 2021Reading time: 12 minutes


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The reduced limb is composed of two main varieties of veins:

Superficial veinsDeep veins

The superficial veins are situated within the subcutaneous tissue whilst the deep veins are uncovered deep come the deep fascia. The deep veins accompany the major arteries and also their branches and are typically paired.

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They are located within a vascular sheath with the corresponding artery, which helps compress and move blood in ~ the veins. Both types of veins contain venous valves, to stop reflux that blood distally, yet they are more numerous in the deep veins. They likewise contain tributaries, other veins which drain into them.

Key facts around the veins the the reduced limb
Superficial veinsGreat saphenous vein (long saphenous vein)Small saphenous vein (short saphenous vein)
Deep veinsVeins of the foot- plantar veins- dorsal veinsVeins that the leg- anterior tibial veins- posterior tibial veins- fibular veinsVeins that the knee- popliteal veinVeins the the thigh- femoral vein and also its tributaries
Clinical relationsVaricose veins, venous thromboembolism, grafting for bypass

This post will discuss the anatomy and also tributaries the the veins of the reduced limb in detail, complied with by any kind of related clinical notes.


Contents
Superficial veins of the lower limbDeep veins the the reduced limb Clinical notes
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The long saphenous vein is additionally referred to together the great saphenous vein and is the longest vein in the human being body. That is a continuation of the medial marginal vein that the foot and also ends in the femoral vein, distal to the inguinal ligament.

It ascends superficial to the medial malleolus, before crossing the distal 3rd of the tibia anteroposteriorly. It overcome behind the medial tibial and also femoral condyles prior to ascending increase the medial element of the thigh and also passing v the saphenous opening, an aperture in the fascia lata the the thigh. That opens right into the femoral vein 2.5 – 3.5 centimeter inferolateral come the pubic tubercle. The long saphenous vein is accompanied by branches of the medial femoral cutaneous nerve throughout its course in the thigh. It has 10-20 venous valves, i m sorry are much more numerous within the leg.

Key facts around the lengthy saphenous vein
SourceMedial marginal vein that the foot
TributariesPosteromedial vein of the thighAnterior femoral cutaneous veinSuperficial epigastric veinSuperficial circumflex iliac veinSuperficial exterior pudendal veinDeep external pudendal vein
Drains toFemoral vein

The lengthy saphenous vein has many connections through the short saphenous vein and the deep veins the the lower limb via perforating veins. Just distal come the knee, the lengthy saphenous vein communicates and receives blood native the little saphenous vein, anterior and also posterior tibial veins. The main tributaries that the lengthy saphenous vein join it in the thigh, close to its junction v the femoral vein. Over there are 6 of such tributaries

Posteromedial vein of the thigh (accessory vein the the thigh) - drains the superficial element of the posteromedial region of the thighAnterior femoral cutaneous vein - a continuation of anterior veins in the distal thigh; it the cross the femoral triangle before opening into the long saphenous veinSuperficial epigastric vein - drains the worse abdominal wall surface and opens right into the long saphenous vein together it traverses the saphenous openingSuperficial circumflex iliac vein - also drains the worse abdominal wall surface and opens into the lengthy saphenous vein together it passes v the saphenous openingSuperficial external pudendal vein - drains component of the scrotum or labia, and additionally opens into the lengthy saphenous vein in ~ the saphenous openingDeep exterior pudendal vein - also join the long saphenous vein in ~ the saphenous opening

Flashcards would certainly be the perfect means to revise every one of these veins. Find out just how you deserve to make your own!

Short saphenous vein


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The short saphenous vein, also referred to as the small saphenous vein, is a continuation of the lateral marginal vein. It passes lateral come the calcaneal tendon and also ascends between the superficial and deep fascia in the distal third of the calf. At the midline the the calf, it penetrates the deep fascia before ascending superficial to the gastrocnemius muscle.

At the junction the the intermediate and proximal thirds of the calf, the quick saphenous vein emerges over the deep fascia prior to passing in between the top of the gastrocnemius muscle. It terminates in the popliteal vein in ~ the popliteal fossa, 3- 7.5 cm above the knee joint.

Key facts around the brief saphenous vein
SourceLateral marginal vein the the foot
TributariesDeep veins of the dorsum the the footCutaneous veins of the leg
Drains toPopliteal vein

The brief saphenous vein has 7-13 valves and also lies near the sural nerve in ~ the leg. ~ above the dorsum that the foot, deep veins drain into the short saphenous vein and also within the leg, the receives plenty of cutaneous tributaries. It has plenty of branches, which interact with the long saphenous vein.

If you want to visualize the veins and understand them also better, take advantage of the videos, illustrations and quizzes consisted of in the complying with study unist:


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main veins the the top limb explore study unit
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Veins of the lower extremity begin quiz

Deep veins of the reduced limb

The deep veins of the lower limb have the right to be be separated into 4 main groups, according to your location:

Veins the the footVeins the the legVein that the kneeVeins of the thigh

Veins that the foot

The foot is composed of two main types of deep veins:

Plantar veins, which drainpipe the plantar surface ar or underside the the footDorsal veins, which drainpipe the dorsal or upper surface of the foot

Venous plexuses in ~ the plantar areas of the toes sign up with to type plantar digital veins. These veins attach with your dorsal counterparts, the dorsal digital veins, to form four plantar metatarsal veins. This veins run proximally in ~ the intermetatarsal spaces and then proceed on to type the deep plantar venous arch. Medial and lateral plantar veins arise indigenous this arch.

A dorsal venous arch is additionally present and is created by the dorsal metatarsal veins, i beg your pardon are likewise formed by the dorsal and plantar digital veins.

Veins that the leg


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The anterior tibial veins are formed by the venae comitantes, or companion veins, that the dorsalis pedis artery.

The posterior tibial veins are created by the medial and also lateral plantar veins and accompany the posterior tibial artery. Veins from the calf muscles drainpipe into posterior tibial veins. They likewise receive relationships from the superficial veins and the fibular veins.

The fibular veins are additionally formed through the medial and also lateral plantar veins and run v the fibular artery. They obtain tributaries indigenous superficial veins and veins draining the soleus muscle.

Vein of the knee

The popliteal vein is situated within the popliteal fossa and also pierces the adductor magnus muscle, whereby it i do not care the femoral vein. Distally it is medial to the popliteal artery. Between the 2 heads of the gastrocnemius muscle it is superficial come it and also proximally it is posterolateral come it.

The popliteal vein usually has actually 4 or 5 valves and many tributaries. Every one of the three main veins the the leg drain into it, and also the short saphenous vein and two muscular veins from each head the the gastrocnemius muscle.

Veins the the thigh


The femoral vein is a continuation of the popliteal vein and also accompanies the femoral artery. It starts at the opened of the adductor magnus muscle and also ends posterior to the inguinal ligament as the exterior iliac vein.

Its relationship to the femoral artery is variable. In ~ the distal adductor canal, the is situated posterolateral to the artery, whilst in the proximal canal and in the apex the the femoral triangle, it lies posterior to the artery. In ~ the base of the femoral triangle, the is found medial come the femoral artery. That is consisted of within the center compartment the the femoral sheath and also usually has four or five valves.

Key facts around the femoral vein
SourcePopliteal vein
TributariesMedial circumflex veinLateral circumflex veinLong saphenous veinProfunda femoris vein
Drains toExternal iliac vein

Tributaries the the femoral vein include:

the medial circumflex veinlateral circumflex veinlong saphenous veinprofunda femoris vein, which drains 4-12 cm distal come the inguinal ligament.

The profunda femoris vein, also referred to together the deep vein that the thigh, is situated superficial come the profunda femoris artery. Veins accompanying the perforating branches of the profunda femoris artery drainpipe the thigh muscles and empty into the profunda femoris vein. The medial and lateral circumflex veins are periodically tributaries the the profunda femoris vein.


Clinical notes

Varicose veins

Varicose veins are typical in the long saphenous vein and also its tributaries and appear due to venous insufficiency. This occurs as soon as the valves become incompetent, bring about retrograde circulation of blood within the veins. This results in dilated and tortuous veins. Symptom include:

tenderness practice intolerance oedema pruritis (itch)

Treatment requires injection of a sclerosing agent, i beg your pardon breaks under the endothelial wall surface of the vein. Complying with treatment and also for avoidance of additional varicose veins, compression stockings room recommended.

Venous thromboembolism

Venous thromboembolism (VTE) is a blood clotting condition that have the right to manifest together deep vein thrombosis (DVT) or a pulmonary embolism (PE). 3 factors, known as Virchow’s triad, are vital in the development of a venous thrombosis. They are:

Venous stasis Activation the blood coagulation Vein damage

DVTs are common in the deep veins of the lower limb and symptoms encompass oedema, tenderness and also erythema (redness). Diagnosis the a DVT requires the utilisation the the Wells Score, i m sorry predicts the probability the a DVT. Points are assigned for symptoms together as current surgery, tenderness and also oedema, among others, and a score greater than or same to 3 says a high probability of a DVT. Treatment requires anticoagulation with pharmocotherapeutic agents such as heparin, warfarin and also factor Xa inhibitors. Compression stockings are offered as a preventative strategy.

Pulmonary embolism (PE) is a very serious complication of DVT in the reduced limb, which can lead to death if a main pulmonary artery is obstructed. That occurs once a thrombus in ~ a deep vein embolises and travels come the lung via the inferior vena cava and the right atrium. Classical symptoms encompass chest pain and shortness the breath. However, PE may current atypically through symptoms such together seizures, syncope (fainting), haemoptysis (coughing up blood) and fever. Treatment v anticoagulation is essential and also may additionally involve thrombolytic treatment with agents such as alteplase.

Grafting for bypass

The long saphenous vein is typically harvested in order to bypass one obstructed coronary artery. The bypass surgery is described as a coronary artery bypass and once harvest the vein is referred to as a graft. The is typically used together it is easily easily accessible and its removed is not problematic due to other collateral circulations in the reduced limb. Before the vein is offered as a bypass that is reversed, so the valves execute not occlude blood flow in the graft.


Sources

References:

K.L. Moore, A.F. Dalley, A.M.R. Agur: Clinically Oriented Anatomy, fifth Edition, Lippincott Williams & Wilkins (2006), p. 580-3.S. Standring: Gray’s Anatomy The Anatomical communication Of Clinical Practice, 40th Edition, Elsevier health and wellness Sciences UK (2008), p. 2503, 2565, 2598, 2657.

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