1. Angiology4 Department of Anatomy Luzhou Medical College
Edited by professor Xiao

2. The veins Concept Characteristics Specially veins Division
Larger cavity
Thinner wall
Lower pressure
Slower flow
Superficial veins
Deep veins
Venous valves
Numerous anastomoses
Concept
Characteristics
Specially veins
Division
Diploic veins
Sinus of dura mater
Systemic veins
(Coronary veins)
Pulmonary veins

3. Ⅰ. The pulmonary veins
They carry oxygenated blood from the lungs to the left atrium. The pulmonary veins are two in number from each lung, superior and inferior, that all of them originate from the capillary network in the oveolar wall and devoid of valves. By repeating junctions tributary veins finally form a single trunk in each lobe (left two and right three). In the pulmonary hilum, the tributaries of each lung form the superior and inferior pulmonary veins draining into the left atrium.
Left superiuor
pulmonary vein
Right superior
pulmonary vein
Left inferior
pulmonary vein
Right inferior
pulmonary vein

4. Pulmonary artery

5. Ⅱ.the systemic veins systemic veins
The head, neck, upper limb, thorax, upper part of the abdominal wall
Superior vena cava
systemic
veins
Greater cardiac vein middle cardiac vein lesser cardiac vein
The vein of the heart
Lower limbs pelvis abdomen
Inferior vena cava

6. 1. Superior vena cava
It is a short venous trunk and is formed by the junction of the two brachiocephalic veins. It begins behind the lower border of the first right costal cartilage, close to the sternum, descends on the right of the ascending aorta and ends in the upper part of the right atrium opposite the lower border of the third sternocostal joint. It receives the azygos vein before superior vena cava joins the right atrium

7. 2. The brachiacephalic veins
Also called innominate vein, each is formed behind the stenoclavicular joint by the union of the internal jugular and the subclavian veins of the same side. The angle of the union is termed the venous angle. The left brachiacephalic vein runs obliquely downwards to the right across the three main branches of the aortic arch, so the left is much longer than the right.
Besides the internal jugular and the subclavian veins, its tributaries also include vertebral , internal thoracic and inferior thyroid veins

8. (1) Internal jugular vein
Collects the blood from the skull, the brain, the superficial parts of face and much of the neck. It begins as a continuation of the sigmoid sinus in the jugular foramen at the skull base. Then the vein runs downwards through the neck with the internal artery, common carotid artery and vagus nerve within the carotid sheath in which the position of the vein is on lateral, the artery on medial, and the vagus nerve lies posteriorly between them.

9. Tributaries Clinic note
The internal jugular vein has thin wall which is united with the carotid sheath to provide beneficial condition for blood return. But when the internal jugular vein is ruptured, it may lead to air embolus.
Clinic note
Deep facial vein
Facial vein It begins at the medial angle of the eye.
superior ophthalmic vein
Cavernous sinus
Angular vein
Facial vein
Tributaries
Facial vein
Internal jugular vein
No valves
Dangerous area
Pterygoid venous
Plexus is located
The temporalis
and The lateral
pterygoid muscles
Superficial temporal vein
Maxillary vein
Retromandibular
vein
emissary foramen

10. Pterygoid plexus and its communications

11. Posterior auricular vein
Superior vena cava
Internal jugular vein
Sternoclavicular joint
Brachiocephalic vein
Posterior division of
retromandibular vein
Subclavian vein
External jugular vein
Posterior auricular vein
Outer border
of the first rib
Clinic note
The wall of the subclavian vein is tightly fastened by
the fascia around it . When the vein is hurt in clinic
operation, the air can go into the vessel through the
aperture, and then could result in the air embolus.
Axillary vein

12. Posterior auricular vein
Posterior division of
retromandibular vein
Anterior division of
retromandibular vein
External jugular vein

13. The veins of upper limb Superficial veins Deep vein Cephalic vein
Median cubital vein
Basilic vein
Dorsal venous rete hand
Dorsal digital veins

14. Azygos Superior vena cava Subclavian vein Accessory hemiazygos vein
Left ascending lumbar vein
Right ascending lumbar vein

15. Inferior vena cava And its tributaries Right atrium Inferior vena cava
Vena cava foramen
Inferior vena cava
Common iliac vein
Fifth lumbar vertebra

16. The tributaries of the inferior vena cava
Inferior phrenic vein
Parietal
tributaries
Lumbar vein
Hepatic vein
Pampiniform plexus
Visceral
tributaries
Right suprarenal vein
Internal vein of the
Spermatic cord
Renal vein
Right testicular vein
(Right ovarian vein)

17. Common iliac vein Internal iliac vein External iliac vein Femoral vein
Parietal tributaries
Inferior epigastric vein
Receive the blood from the
regions which the corresponding
Arteries supply.
Superior rectal vein
Inferior rectal vein
Internal pudendal vein
(rectal venous plexus)
Internal and external rectal plexuses
Visceral tributaries

18. The veins of the lower limb
Deep vein
Superficial veins
Superficial iliac circumflex v. Superficial epigastric v. Superficial lateral femoral v. superficial medial femoral v. External pudendal v.
Femoral vein
Popliteal vein
Great saphenous vein
Small saphenous vein
In front of the medial malleolus is superficial and its location is almost no variability, so it often used to transfuse and inject in clinic.
Dorsal venous arch of foot

19. The hepatic portal vein
Collects the blood from the abdominal part of the digestive canal, except the anal canal, and from the pancreas, the spleen and the gallbladder and the liver.
Inferior mesenteric vein
Splenic vein
Superior mesenteric vein
form
The hepatic portal vein
Hepatoduodenal ligament
Tributaries
Characteristics
Between two sets
of capillaries
No valves
High pressure in
portal vein the
blood can flow
adversely
It is a functional
vessel of liver
Superior mesenteric vein
Splenic vein
Inferior mesenteric vein
Left gastric vein
Right gastric vein
Paraumbilical vein
Cystic vein

20. 1. anastonoses through the esophageal venous plexus
The anastomoses between the hepatic portal venous system and vena cava system
1. anastonoses through the esophageal venous plexus
Hepatic v left gastric v esophagus v. esophageal venous plexus esophageal v azygos v superior vena cava.
2. the anastomoses through the rectal venous plexus
Hepatic v Splenic v Inferior mesenteric v Superior rectal v Rectal venous plexus inferior rectal v. and anal v Internal iliac v Common iliac v Inferior vena cava.

21. 3. The anastomoses through periumbilical venous rete
Hepatic portal v paraumbilical v. periumbilical venous rete The following routes
①Superficial epigastric v Great saphenous v. Femoral v External iliac v Common iliac v.
Inferior vena cava
②Thracoepigastric v Lateral thoracic v Axillary v Subclavian v Brachiocephalic v.
Superior v.
③ Superior epigastric v Internal thoracic v. Brachiocephalic v Superior vena cava
4. vertebral veins, lumbar veins and anastomose with the veins of the posterior wall of the abdomen and the posterior wall of the thorax.

22. 4. vertebral veins, lumbar veins and anastomose with the veins of the posterior wall of the abdomen and the posterior wall of the thorax.
5. Anastomoses through the union between small veins posterior wall, the small tributaries of the superior and inferior mesenteric veins anastomose with the small divisions of the posterior intercostal vein, the inferior diaphragm vein, the renal vein and testicular vein.

23. Paraumbilical veins
Cystic vein
Left gastric vein
Right gastric vein
Splenic vein
Superior mesenteric v.
Inferior mesenteric v.
Hepatic portal vein

24. The types of the hepatic portal vein

26. Great saphenous vein
Small saphenous v.
The dorsal venous
arch of the foot

29. Superior rectal vein
External rectal plexus
Internal rectal plexus

30. The lymphatic system
The lymphatic system is an accessory system of the cardiovascular system.
The blood— blood capillaries—certain fluid elements filter through the wall of the capillaries into the tissue spaces and become the tissue fluid.
The tissue fluid is mostly taken up by the blood capillaries, partly by the lymphatic capillaries.
Composition
Lymphatic system consists of the lymph conducting channels, lymphoid tissues and lymphoid organs.
Lymph tissues: contain lymphocytes. Diffused lymphoid tissues and
lymph nodules. Such as aggregated lymphatic follicles.
Lymphoid organs: lymph nodes, tonsils, thymus and spleen.
Lymphoid vessels: lymphatic capillaries, lymphatic vessels, lymphatic
trunks and the lymphatic ducts

31. The absent of the lymphatic capillaries
The lymph conducting vessels
1. The lymphatic capillaries
Dilated blind ends and form network in the tissue spaces. The wall of lymphatic capillaries consists of a single layer of verlapping endothelial cells attached by anchoring filaments to surrounding connective Tissue. The basal lamina is often lacking and the pericytes are absent.
The absent of the lymphatic capillaries
Specialized lymphatic capillaries
Epidermis. Hair. Nails. Cornea. Lens. Vitreous body. Articular cartilage. Splenic pulp. Bone marrow. Enament. Central N.S.
Intestinal villi
Absorb the fat from the small intestine

32. 2. Lymphatic vessels 3. Lymphatic trunks 4. The lymphatic ducts
Superficial lymphatic vessels
valves
Deep lymphatic vessels
Left and right jugular trunks
Left and right subclavian trunks
Left and right bronchomediastinal trunks
Left and right lumbar trunks
Intestinal trunk
Thoracic duct
Right lymphatic duct

33. The lymph nodes position form Clinic note Regional lymph nodes
Lying in the course of lymphatic vessels
Arranged in groups in certain place
position
Oval or bean-shaped bodies
A slightly depression—hilum
Efferent lymphatic vessels at hilum
Afferent lymphatic vessels at periphery
form
Regional lymph nodes
Lymph from an area of body is drained into the local corresponding lymph nodes. These nodes termed regional lymph nodes
Clinic note
One feature of lymphatic system
Is significance is the spread of tumor
Cancer usually produces a secondary
Growth (metastases).

34. The lymphatic ducts Left venous angle Right venous angle
The thoracic duct
Right lymphatic duct
Left cervical trunk
Left subclavian trunk
Left bronchomediastinal trunk
Posterior mediastinum
Aortic hiatus
Right cervical trunk
Right subclavian trunk
Right bronchomediastinal trunk
Cisterna chyli
Left and right lumbar trunks
Intestinal trunk

35. Deep lateral cervical lymph nodes
Lymphatic
Drainage
The lymphatic
drainage of the head and neck
The lymph nodes of the head lie in the boundary between the head and neck
they consist of the occipital, mastoid, parotid, submandibular and submental lymph nodes
Deep lateral cervical lymph nodes

36. Lymphatic Drainage The lymphatic drainage of the head and neck
The lymph nodes of the neck
Anterior cervical lymph nodes
Superficial group
Deep group
Lateral cervical lymph nodes
Superficial group
Deep group

37. Deep Lateral Cervical Lymph nodes Superior group Inferior group
Inferior deep lateral cervical lymph nodes
Transverse cervical chain of nodes
Supraclavicular nodes

38. Deep Lateral Cervical Lymph nodes Inferior group
Inferior deep lateral cervical lymph nodes
Transverse cervical chain of nodes
Supraclavicular nodes
Virchow’s lymph node
The lymphatic efferents of the head and neck unite to form the left and right trunk.

39. The lymphatic drainage of the upper limb
All of the vessels of the upper limbs drain into the terminal roup of lymph nodes, the axillary lymph nodes. The superficial tissues are drained by vessels which accompany the superficial veins to pass to the axillary nodes either directly, or indirectly. The deep lymph nodes follow the principal neurovascular bundle and end in the lateral group of the axillary lymph nodes.
1. Cubital lymph nodes
They are superficial to the deep fascia above the medial epicondyle of the humerus and near the deep blood vessels of the cubital fossa.

40. 2. The Axillary Lymph
which are in the loose connective tissue of the axillary fossa and arranged along the blood vessels. They vary from twenty to thirty in number, and are divided into five groups.
①. Anterior group or pectoral lymph nodes
②. Lateral lymph nodes
③. Posterior lymph nodes or subscapular lymph nodes
④. Central lymph nodes
⑤. apical lymph nodes
The efferents of this group unite to form the subclavian trunk.

41. The lymphatic drainage of the thorax
Lymph of anterior wall of thorax
The parasternal lymph nodes
The intercostal lymph nodes
The superior phrenic lymph nodes

42. Posterior wall of the Thoracic Cavity
The intercostal lymph nodes
The superior phrenic lymph nodes

43. The lymph nodes of the thoracic Contents
Anterior mediastinal lymph nodes
Posterior mediastinal lymph nodes
The lymph nodes of the trachea, bronchi and lungs

44. The lymph nodes of the trachea, bronchi and lungs
The pulmonary lymph nodes
The broncheopulmonary hilar lymph nodes
The tracheobronchial lymph nodes
The paratracheal lymph nodes
The efferents of the contents of the thorax to form left and right bronchomediatinal trunks

45. The superficial lymphatic vessels
Lymphatic drainage of the abdomen
The lymph nodes of
the abdominal wall
The superficial lymphatic vessels
from the anterior abdominal wall above the umbilicus follow the superficial blood vessels to the axillary nodes; the part below umbilicus is drained to the superficial linguinal lymph nodes.
The deep lymphatic vessels from the posterior abdominal wall pass directly, along the course of the lumbar arteries, to lumbar lymph nodes. Those from the upper part of the anterior wall run with the superior epigastric vessels to reach the parasternal lymph nodes; those of the lower part end in the external iliac lymph nodes.

46. The lumbar lymph nodes lies alongside the abdominal aorta and inferior vena cava. They receive afferents from the posterior abdominal wall, the abdominal paired viscera and from the common iliac nodes. Their effrents unite to form the right and left lumbar trunks.
The lymph of the posterior abdominal wall
The lymph of the abdominal paired viscera
Lumbar lymph nodes
Common iliac nodes
Internal lymph nodes
External lymph nodes
The lymph nodes of the lower limb

47. The lymph nodes of the abdominal viscera
The lymphatic drainage of the unpaired viscera of the abdominal cavity
Celiac lymph nodes
Superior mesenteric
lymph nodes
Inferior mesenteric
lymph nodes

48. ①. Right and left gastric lymph nodes
The celiac lymph nodes They lie on the front of the abdominal aorta close to the origin of the celiac artery. They are the terminal group for the stomach, deodenum, liver, gallbladder, pancreas and spleen, and their afferents are derived from the outlying lymph nodes which are placed along branches of the celiac artery.
①. Right and left gastric lymph nodes
②. Right and left gastroepiploic
lymph nodes
③. Pyloric lymph nodes
④. Hepatic lymph nodes
⑤. Pancreaticosplenic lymph nodes

50. The superior mesenteric lymph nodes
Inferior mesenteric lymph nodes

51. The lymphatic drainage of the pelvis
①. Sacral lymph nodes
②. Internal iliac lymph nodes
④. Common iliac lymph nodes
③. External iliac lymph nodes

52. The lymphatic drainage of the lower limbs
Most superficial lymphatic vessels follow the great saphenous vein to end the lower group of the superficial inguinal lymph nodes; others run with the small saphenous vein to the popliteal lymph nodes. The deep lymphatic vessels accompany the main blood vessels of the limb. The deep lymphatic vessels of the foot and leg are interrupted by the popliteal lymph nodes, but those from the thigh pass direct to the deep inguinal lymph nodes.
The popliteal lymph nodes
They are imbedded in the fat if the popliteal fossa. The nodes are near the end of the small saphenous vein and arranged along the popliteal blood vessels. They receive afferents from the deep lymphatic vessels which accompany the anterior and posterior tibial vessels, and superficial lymphatic vessels from the lateral border of the foot, and the back lateral side of the calf of the leg. Their efferents pass to the deep inguinal lymph nodes

53. The inguinal lymph nodes
①.The superficial inguinal lymph nodes
They are arranged in two groups. The upper group forms the a chain immediately below the inguinal ligament. The lymphatic vessels from the lower part the abdominal wall, external genitalia, gluteal region and perineum pass this group. The lower group is disposed vertically along the terminal part of the great saphenous vein. It receive all the superficial lymphatic vessels of the lower limb, with the exceptionof those from the lateral border of the foot, and the back and lateral side of the calf of the leg. All the superficial inguinal lymph nodes send their efferents to the deep inguinal lymph nodes and the external iliac nodes.

54. ②. The deep inguinal lymph nodes
They are situated medial to the femoral vein and in the femoral canal. They receive lymph from the deep structures of the lower limb and perineum, and the afferents from the superficial inguinal and popliteal lymph nodes. The efferents pass to the external iliac lymph nodes.

55. The lymphatic drainage of the mammary gland
Efferents vessels of the mammary gland mainly drain to the axillary lymph nodes. There are 3drainage directions:
①. Efferents vessels of the lateral and central part drain to the pectoral lymph nodes.
②. Efferents vessels of the superior part to the apical lymph nodes and subclavicular lymph nodes.
③. Efferents vessels of the medial part to the parasternal lymph nodes. Superficial lymphatic vessels of the medial part of the organ communicate with the vessels of the opposite side.
④. Lymphatic vessels of the medioinferior part communicate with the hepatic lymphatic vessels by the epigastric lymphatic vessels and inferior phrenic lymphatic vessels.

56. The spleen It is the largest lymphoid organ in
The body. and is surrounded by
Peritoneum
Function
Main functions are erythrocyte
Storage, phagocytosis, cytopoiesis
and immune responses.
Position
Lies in the left hypochondriac region of the abdomen. It is situated between
The fundus of stomach and diaphragm and deep to the 11th left ribs. Its
long axis corresponds to the 10th ribs. The normal spleen is not palpable
below the left costal margin unless it is enlarged or markedly dislocated.
Form
Soft, fragile, dark purplish color.
Has two surfaces (diaphragmatic and visceral), two borders (superior and
inferior) and two extremities (anterior and posterior).

57. The hilum of spleen Splenic notch
Diaphragmatic surface is convex, smooth and faces upwards. It is in
relation with the abdominal surface of the diaphragm.
Visceral surface is directed towards the abdominal cavity, and
presents gastric, renal, pancreatic and colic impressions.
The hilum of spleen
It has a long fissure near
The center of its visceral
Surface. It is for the exit
And entrance of blood
Vessels and nerves.
Splenic notch
Splenic notch
Hilum of spleen
Superior border is sharper
And marked, near its lateral
End, by two or three splenic
Notches of variable depth,
Which can be recognized
When the spleen is enlarged
Visceral surface

59. Test for Angiology 1. The entrances of the left and right atria?
2. The boundary between the inflow and outflow in the
right ventricle?
3. Describe the fibrous skeleton of the heart?
4. The conduction system of the heart includes?
5. Define the systemic circulation.
6. Describe the arterial supply of the thyroid gland.
7. Describe the arterial supply of the stomach.
8. Describe the hepatic portal vein and its tributaries.
9. Describe the cubital arterial network.
10. Describe the dangerous triangle of the face and the
communications of the facial vein.