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Key Words
Adventita
Media
Intima
Posterior Tibial
Anterior Tibial
Peroneal
Tibial/Peroneal Trunk
Popliteal
Superficial Femoral
Profunda Femoral
Common Femoral
External Iliac
Internal Iliac
Common Iliac
Inferior Vena Cava
Greater Saphenous
Lesser Saphenous
Sinuses
Perforators
Radial
Ulnar
Interosseous
Brachial
Axillary
Subclavian
Brachiocephalic
Superior Vena Cava
Cephalic
Basilic
External Jugular
Hydrostatic Pressure
Transmural Pressure
Virchow’s Triad
Effort Thrombosis
Valvular Incompetence

 

ANATOMY

GENERAL POINTS

Venous anatomy is divided into three systems: deep, superficial and perforating. A primary characteristic of the deep veins is that they run alongside the arteries, and as such, often share the same name. Blood flows from the superficial veins into the deep veins. Perforating veins act as communicating veins between the deep and superficial systems. Unique to the veins are venous valves, which permit unidirectional flow toward the heart.

WALL STRUCTURE
The deep vein wall consists of three layers. The outside layer, called the adventitia, is made of collagen, vasa vasorum and nerve cells. The middle layer, or media, is comprised of smooth muscle. The inside layer, or intima, is made up of endothelial cells which provide a nonthrombogenic surface for flowing blood. The venous valves are formed from folds of the intimal


Figure 1. Vein Anatomy

COURSE OF MAJOR VEINS OF THE LOWER EXTREMITIES
DEEP VEINS
POSTERIOR TIBIAL (PTV)

The posterior tibial veins arise from the foot veins behind the medial malleolus (ankle). They run up the medial aspect of the calf to join the peroneal veins in the upper calf.

ANTERIOR TIBIAL (ATV)
The anterior tibial veins are formed by the venous network of veins on the dorsum of the foot. They course up the leg between the tibia and the fibula, and join the tibial/peroneal trunk to form the popliteal vein in the upper calf.

PERONEAL (PV)

The peroneal veins can be located on the lateral aspect of the calf, behind the fibula. They join the posterior tibial veins in the upper calf.

TIBIAL/PERONEAL TRUNK

This short vein segment is located in the upper calf, where the posterior tibial and peroneal veins join.

POPLITEAL (POP)

The popliteal vein begins as the anterior tibial vein joins the tibial/peroneal trunk in the upper calf. There are a number of veins which join the popliteal, including the sural veins and the lesser saphenous vein.


Figure 2. Depicts the major deep, superficial and perforating (communicating) veins of the lower extremities. Note that the deep calf veins are bifid (two veins for each artery).  Click on structure or label for identification.

SUPERFICIAL FEMORAL (SFV)
Despite the name, this long vein segment is a deep vein. The popliteal vein becomes the SFV as it dives at the level of the adductor canal in the low thigh. The SFV runs medially up the thigh to join the profunda femoral in the upper thigh.

PROFUNDA FEMORAL (PFV)
Also called the deep femoral, this vein drains the thigh muscles and courses up the thigh to join the SFV.

COMMON FEMORAL (CFV)
The superficial femoral and profunda femoral veins join just below the groin to form the common femoral vein. The common femoral courses more superficially and is generally very easy to image. The greater saphenous vein joins the common femoral in the groin, just proximal to the PFV/SFV junction in the upper thigh.

EXTERNAL ILIAC (EIV)
The common femoral vein dives deep into the abdomen about the level of the inguinal ligament, where it becomes the external iliac vein.

INTERNAL ILIAC (IIV)

The internal iliac drains the pelvis and joins the external iliac to form the common iliac vein.

COMMON ILIAC (CIV)

The external iliac joins the internal iliac vein from the pelvis to form the common iliac.

INFERIOR VENA CAVA (IVC)

The right and left common iliac veins join at the level of the navel where they form the inferior vena cava. The IVC then courses up to the right atrium of the heart.

SUPERFICIAL VEINS

GREATER SAPHENOUS (GSV)

This is the longest vein in the body. It runs from the medial foot, anterior to the medial malleolus (ankle) and up the medial leg to the groin, where it connects to the common femoral vein. The GSV has many tributaries (branches) along its course.

LESSER SAPHENOUS (LSV)

The lesser saphenous vein courses up the posterior calf from the lateral malleolus, usually into the popliteal vein behind the knee. However, the lesser saphenous vein is highly variable in its end point, and may empty into the GSV in the thigh. Like the GSV, the LSV also has a number of branches.

 
 
 
 
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