URR Lower Extrem Venous Anatomy

Question 1

difference between vein compared to artery

Answer 1

-thin walled, collapsible
-media layer thinner than artery

Question 2

walls of the upper extrem veins contain much les muscle than walls of the veins in the lower extrem and especially the feet due to what

Answer 2

hydrostatic pressure

Question 3

venules in the extrem (hands/feet) travel to where

Answer 3

the right atrium

Question 4

capillary beds are composed of intima only and connect to where

Answer 4

venules

Question 5

venules are missing what layer in their walls?

Answer 5

no media layer

Question 6

pressure in venules normally does not exceed what?

Answer 6

20 mmHg

Question 7

how much blood in the body is found in the venous system?

Answer 7

80%

Question 8

refers to a vein that is usually paired, w/ a vein lying on either side of a single artery

Answer 8

concomitant veins or venae comitantes
(radial, ulnar, PTV, ATV, peroneal and gastrocnemius veins)

Question 9

in vasculature, proximal refers to what?

Answer 9

being closest to the heart

Question 10

what is considered the central veins?

Answer 10

-inferior vena cava
-hepatic veins
-superior vena cava
-portal vein - confluence of SMV and splenic vein

Question 11

where are the anterior tibial veins?

Answer 11

-drain blood from the anterior calf
-2 veins originate at the plantar arches
-course cephalad anterolateral to the tibial bone and the interosseous membrane to reach the tibioperoneal trunk
-travels between the tibial head and fibula head to join the pop V
-best scan approach is anterior calf w/ slightly lat probe position

Question 12

where are the posterior tibial veins?

Answer 12

-drains blood from the posterior calf
-2 veins originate at the confluence of the plantar arches
-at the ankle the PTVs course posterior to the medial malleolus and anterior to the achilles tendon then course cephalad through the calf posterior to the tibial bone
-best scan approach is to place the probe on the medial calf, angling through to the lateral side; PTVs most anterior on image and peroneals visible beneath them

Question 13

deep veins of lower extrem?

Answer 13

-deep digital veins
-metatarsal veins
-deep venous arches
-PTVs and peroneals
-tibioperoneal trunk
-ATVs
-popV
-FV
-CFV
-external iliac

Question 14

where are the peroneal veins, what do they drain?

Answer 14

-drain blood from lateral calf
-in the lower calf/ankle 2 veins course lateral to the PTV and medial to the fibula
-continue cephalad course up the midline of the posterior calf, posterior to the fibula
-2 peroneal veins and 2 posterior tibial veins merge to form a single tibio-peroneal trunk in the upper calf
-best scan approach is to place probe on the medial calf, angling through to the lateral side; PTVs most anterior on image and peroneal visible beneath them

Question 15

where is the pop vein and what forms it?

Answer 15

-tibioperoneal trunk merges with the two anterior tibial veins to form the pop v in the pop fossa
-courses posterior to the pop artery
-becomes the FV at adductor hiatus in the distal thigh
-best scan approach is to place probe on the posterior pop fossa; pop V demonstrated ANTERIOR to the pop A on the image due to scan approach

Question 16

another name for FV? what does it join and course?

Answer 16

-superficial FV
-extends from adductor hiatus to join the profunda femoral vein at the groin
-courses posterior to the Fem A

Question 17

another name for profunda femoral V? what does it join, and what does it drain?

Answer 17

-deep femoral vein
-joins the femoral vein to form the CFV just below inguinal ligament
-drains the muscles in the thigh (quadriceps)

Question 18

where is the CFV? formed by?

Answer 18

-formed by the junction of the FV and PFV, just below the inguinal ligament
-courses beneath the inguinal ligament
-becomes external iliac vein above inguinal ligament at groin crease
-courses medial and posterior to the CFA

Question 19

what does the internal iliac vein drain and where does it course?

Answer 19

-courses medial to the external iliac vein
-drains the pelvic organs (not the gonads)

Question 20

where does the external iliac vein course and what does it join?

Answer 20

-courses lateral to the internal iliac vein and anterior to the external iliac artery
-joins the internal iliac vein to form common iliac

Question 21

where is the common iliac and what does it empty into?

Answer 21

-courses anterior to the common iliac A
-right and left common iliac veins merge at the level of L5 to form the IVC
-IVC empties into the right atrium

Question 22

what is klippel - trenaunay - weber syndrome?

Answer 22

-congenital absence of segments of the deep veins; can also cause absence of valves and veins w/ smaller diameter than normal
-causes numerous superficial varicosities and clusters of varicosities

Question 23

how do they categorize superficial veins of the lower extrem?

Answer 23

-located w/in 2 cm of the skin surface
-course within the subcutaneous fat layer of the leg
-veins of the superficial system always course between the superficial and deep fascial layers; use this characteristic location to differentiate from dilated tributaries of the superficial system
-minimal transducer pressure is required for eval of superficial veins
-transducer pressure that is too great can compress these veins causing nonvis

Question 24

what is the longest vein in the boy?

Answer 24

GSV

Question 25

where is the GSV what does it connect?

Answer 25

-originates on the dorsum of the foot at the medial end of the distal venous arch
-travels anterior to the medial malleolus
-ascends medial thigh with the great saphenous nerve
-joins the medial aspect of the CFV
-penetrates the deep fascia through the foramen ovale in the groin and terminates at the saphenofemoral junction (SFJ)
-the SFJ is adjacent to the inguinal ligament
-also connects to deep system through multiple perforating veins
-superficial epigastric vein is the most prox tributary of the GSV and usually descends into groin to join the GSV near the saphenofemoral junction

Question 26

which vein is commonly used as a bypass graft for cardiac and arterial bypass surgery?

Answer 26

GSV

Question 27

what is the anterior accessory saphenous vein?

Answer 27

-most easily identified at the groin
-ascends along the thigh to join the GSV near the groin

Question 28

what is the alignment sign?

Answer 28

-differentiates from the GSV by its course anterior to the femoral artery instead of medial to it (GSV)
-not visible in all patients; can be a sign of dilated superficial system and reflux

Question 29

what is the small saphenous vein (SSV)

Answer 29

-also known as short saphenous vein
-dorsal vein of the little toe joins the lateral end of the dorsal venous arch to form the SSV
-originates posterior to the lateral malleolus and achilles tendon
-ascends along the midline aspect of the posterior calf to enter the pop space between the two heads of the gastrocnemius muscles
-usually joins the pop v in knee/distal thigh area by many variations in termination possible
-course of the vessel on the posterior calf describing as a “stocking seam”
-numerous small intersaphenous veins connect the SSV to the GSV in the calf
-SSV perforators connect to the gastrocnemius or peroneal veins

Question 30

what are the perforators?

Answer 30

-connect superficial and deep systems to equalize pressure between the two systems
-only direct connections btwn the deep and superfical systems are the saphenofemoral junction and sapehenopop junction
-allow flow from the superficial to the deep system throughout the thigh and calf
-begin in the saphenous compartment and penetrate deep fascia to join the deep veins
-normal flow centripetal or from superficial toward the center of the leg to the deep
-each perforator only has one valve that allows unilateral flow directino from superficial to deep
-PTV connected to distal GSV near ankle

Question 31

where are perforators?

Answer 31

-3 ankle perforators called posterior tibial perforators (formerly Cocketts perforators)
-paratibial perforators (formerly Boyds perforators) located in knee area; connect GSV and PTVs
-distal thigh perforators (dodds perforators) located in distal thigh; connect GSV to FV
-hunterian perforators located in prox thigh; connect GSV to FV
-lateral perforator connects to SSV near the mid calf
-each leg normally has about 100 perforators
-normally < 2 mm diameter, > 4 mm usually has reflux
-ankle perforator damage/dilatation involved in stasis ulcers
-dilated perforators can occur in response to DVT formation

Question 32

what are communicating veins

Answer 32

-connect the great and small saphenous veins
-never penetrate the deep fascia
-posterior arch vein extends cephalad from the ankle to join the GSV in the mid calf; communicates w/ the posterior tibial perforators (cocketts) and plays major role in venous stasis ulcers
-vein of giacomini originates at the saphenopop junction (SSV/POP) behind the knee and extends up the posterior thigh to become the posterior cicumflex vein that joins the GSV

Question 33

what are the sural veins (sinusoid or saccular veins) and where are they

Answer 33

-serve as blood reservoirs for the legs
-located btwn the soleal and gastrocnemius muscles
-important for calf muscle pump and lower extrem venous flow
-also called the gastrocnemius plexus
-group of calf veins
-have an accompanying artery w/ each set
-may see 3 pairs
-most commonly drain into the pop V
-cannot be followed to the ankle and this characteristic can be used to differentiate them from tibial veins

Question 34

what is a soleal plexus/soleal sinus

Answer 34

-thick walled reservoirs w/in the soleal muscle
-no A w/ them
-DO NOT contain valves
-drain into either the posterior tibial or peroneal veins
-most lower extrem DVT starts in these vessels

Question 35

what are valves and what are their purpose?

Answer 35

-extensions of the intimal layer
-valves contain two leaflets (bicuspid)
-primary purpose is to allow unilateral flow direction in veins
-helps keep flow moving from superficial to deep system and from peripheral to deep veins
-the GSV has the most valves because it is the longest vein in the body and it is located outside the muscle tissue
-each perforating vein has single valve