1. Vascular Technology Lecture 22 : Venous Gross Anatomy HHHoldorf

2. Venous Gross Anatomy Lower Extremity Veins
Note: The anatomical relationship of the veins to the heart is the same as for the arteries. Veins located at the ankle are considered distal: while veins located closer to the heart (e.g., Femoral) are considered more proximal
Note: Be sure to know the orientation of vessels from medial to lateral and from lateral to medial

3. The paired, deep veins of the calf (Anterior Tibials, Peroneals, and posterior tibilas, follow the corresponding arteries: are called comitantes (corresponding veins).

4. Paired peroneal veins (PerV)
Formed by confluence of venules
Empties the lateral leg
Paired veins may form common trunk and carry blood cephalad into tibial-peroneal trunk
Paired posterior tibial veins (PTV)
Empties back of leg

5. Paired anterior tibial veins (ATV)
Formed by confluence of venules
Empties front of leg
Popliteal vein (PopV)
Formed by union of ATV and Tib-Peroneal Trunk
Usually just below the knee
Becomes femoral vein (previously called superficial femoral vein) when passes through adductor hiatus in lower thigh

6. Adductor hiatus
The adductor hiatus is a hiatus (gap) between the adductor magnus muscle and the femur that allows the passage of the femoral vessels from the anterior thigh to the posterior thigh and then the popliteal fossa.

8. Common Femoral Vein (CFV)
Femoral Vein (FV)
Popliteal vein becomes FV when vein passed through adductor hiatus
Common Femoral Vein (CFV)
Formed by joining of FV & Deep femoral vein

9. Common Femoral Vein 5 Formed by 6 and 8

10. External iliac Vein (EIV)
Common femoral vein becomes EIV when passes through inguinal ligament
Common Iliac Vein (CIV)
Formed by confluence of external and internal iliac veins

11. The inguinal ligament

12. Because the left common iliac vein passes under the right common iliac artery, extrinsic compression may be evident.
This pressure point may account for left sided DVT; also known as May-Thurner Syndrome

13. May-Thurner Syndrome

14. Inferior Vena Cava (IVC)
Formed by confluence of common iliac veins
Commonly at level of 5th lumbar vertebra
Carries blood into right atrium of heart

15. Superficial Veins Small saphenous (formally lesser) vein (SSV)
Ascends back of calf joining popliteal vein

16. Superficial Veins Great (formerly Greater) Saphenous Vein (GSV)
Longest vein in the body, originating on dorsum of foot, traveling medially to saphenofemoral junction in the groin (about level of CFA bifurcation)

17. Great Saphenous Vein

18. Perforators Carry blood from superficial veins into deep veins
Posterior arch vein
Has three ankle perforators
Plays major role in development of venous stasis ulcers

19. Blood Flows from superficial veins (S) to the deep venous system (D)

20. Important perforators of the Posterior Arch Vein

21. Posterior arch vein

22. Venous Sinuses Intracranial: Lower extremity:
Spaces between dura mater and periosteum that drain blood into the Internal Jugular Vein
Lower extremity:
Dilated channels in soleal and gastrocnemius muscles
Drains blood into the posterior tibial vein and Peroneal Vein
Major part of calf muscle pump

24. Upper Extremity Veins Deep Veins
The paired deep veins of the arm follow the corresponding arteries; called venae comitantes (corresponding veins)
Radial veins
Ulnar veins
Brachial veins

25. Deep Veins of the upper extremity

26. Paired radial veins (RadV)
Formed by confluence of venules
Empties lateral hand and forearm
Paired ulnar veins (UlnV)
Empties medial hand and forearm

27. Paired brachial veins (BraV) Axillary veins (AxV)
Formed by confluence of radial and ulnar veins
Axillary veins (AxV)
Formed by confluence of brachial vein and basilic vein (basilic vein is in the superficial system)
Subclavian vein (SubV)
Formed by the confluence of axillary vein and cephalic vein (cephalic vein is superficial system

28. Innominate vein (InnV)
Formed by confluence of subclavian vein and internal jugular (Also called brachiocephalic)
Superior vena cava (SVC)
Formed by confluence of right and left innominate veins
Carries blood into right atrium

30. Superficial Veins Basilic Vein: Formed by the digital veins
Empties medial aspect of arm
Joins brachial vein to form axillary vein
Can be harvested for arterial bypass conduit

31. Cephalic vein
Formed by digital veins
Empties lateral aspect
Joins axillary vein to form subclavian vein
Can be harvested for arterial bypass conduit

32. Central veins Superior Vena Cava (SVC) Inferior Vena Cava (IVC)
Formed by confluence of innominate veins
Drains head and upper extremity veins
Terminates in right atrium
Inferior Vena Cava (IVC)
Formed by confluence of common iliac veins
Drains lower half of body

33. Portal System Portal vein
Formed by superior mesenteric and splenic veins
Drains abdominal part of digestive tract, pancreas, spleen, and gallbladder
Carries blood into sinusoids of liver (hepato- petal flow)
Carries approximately 80% of blood flow to the liver

34. Renal veins – empties into the IVC
Hepatic Veins
Carries blood from the liver into IVC (flow away from the liver called hepato-fugal)
Renal veins – empties into the IVC

35. Structural Anatomy of Veins
Function
Thin walled, collapsible tubes that transport blood from capillaries toward heart
Carry away waste products of cellular activity
Not completely passive structures; have some element of reactivity, which may be referred to as veno-motor tone; contraction of smooth muscle cells can occur in response to stimulation of sympathetic nervous system, i.e., temperature, exercise, stress, traume

36. Anatomy
Same three layers as arteries, e.g., intima, media, adventitia (Media layer very thin)
Venous system starts at capillary level with progressive increase in size (venules smallest – vena cava – largest)

37. Venous Valves Extensions of intimal layer
Bicuspid structures providing unidirectional flow
Valves of lower extremities more susceptible to disease secondary to the effects of venous thrombosis, increased ambulatory venous pressure from gravity, increased intraabdominal pressure and or venous obstruction.

38. Venous Valves

39. Veins without Valves Soleal sinuses
External iliac vein: contains valves approximately 25% of the time
Common Iliac and internal iliac
Innominate
Superior and Inferior vena cava

40. Veins With Valves
Great saphenous vein has approximately 12 valves: most are below the knee
Small Saphenous: valves
Perforators: each contains a valve
Intrapopliteal (deep veins: 7 – 12 valves each
Popliteal and femoral: 1-3 valves each
External iliac vein: contains valves approximately 25% of the time
Common femoral: 1 valve
Jugular Vein: 1 valve
Basilica and cephalic: 1 valve each
Variable number of UE deep veins has valves

50. Additional Notes: Lower extremity venous Peroneal veins are paired
Posterior tibial veins par paired
Take note if May-Thurner Syndrome
Upper extremity veins
Know medial to lateral and lateral to medial

51. Hepatic blood flow direction
Hepato-petal flow is blood flow into the liver
Hepato-fugal flow is blood flow away from the liver
Veins with valves
Where the most of the valves are: the further away from the heart!!
The closer to the heart, the least likely for a vein to have a valve.

52. Homework Textbook: Chapter 24 SDMS Assignments
Gross Anatomy of the Central Peripheral Venous systems
Pages 265 – 276
SDMS Assignments