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.
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
1. Vein Anatomy
COURSE OF MAJOR VEINS OF THE LOWER EXTREMITIES
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.
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
This short vein segment is located in the upper calf, where the
posterior tibial and peroneal veins join.
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
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.
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.