URR Lower Extrem Venous Anatomy Flashcards
difference between vein compared to artery
-thin walled, collapsible
-media layer thinner than artery
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
hydrostatic pressure
venules in the extrem (hands/feet) travel to where
the right atrium
capillary beds are composed of intima only and connect to where
venules
venules are missing what layer in their walls?
no media layer
pressure in venules normally does not exceed what?
20 mmHg
how much blood in the body is found in the venous system?
80%
refers to a vein that is usually paired, w/ a vein lying on either side of a single artery
concomitant veins or venae comitantes
(radial, ulnar, PTV, ATV, peroneal and gastrocnemius veins)
in vasculature, proximal refers to what?
being closest to the heart
what is considered the central veins?
-inferior vena cava
-hepatic veins
-superior vena cava
-portal vein - confluence of SMV and splenic vein
where are the anterior tibial veins?
-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
where are the posterior tibial veins?
-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
deep veins of lower extrem?
-deep digital veins
-metatarsal veins
-deep venous arches
-PTVs and peroneals
-tibioperoneal trunk
-ATVs
-popV
-FV
-CFV
-external iliac
where are the peroneal veins, what do they drain?
-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
where is the pop vein and what forms it?
-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
another name for FV? what does it join and course?
-superficial FV
-extends from adductor hiatus to join the profunda femoral vein at the groin
-courses posterior to the Fem A
another name for profunda femoral V? what does it join, and what does it drain?
-deep femoral vein
-joins the femoral vein to form the CFV just below inguinal ligament
-drains the muscles in the thigh (quadriceps)
where is the CFV? formed by?
-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
what does the internal iliac vein drain and where does it course?
-courses medial to the external iliac vein
-drains the pelvic organs (not the gonads)
where does the external iliac vein course and what does it join?
-courses lateral to the internal iliac vein and anterior to the external iliac artery
-joins the internal iliac vein to form common iliac
where is the common iliac and what does it empty into?
-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
what is klippel - trenaunay - weber syndrome?
-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
how do they categorize superficial veins of the lower extrem?
-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
what is the longest vein in the boy?
GSV
where is the GSV what does it connect?
-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
which vein is commonly used as a bypass graft for cardiac and arterial bypass surgery?
GSV
what is the anterior accessory saphenous vein?
-most easily identified at the groin
-ascends along the thigh to join the GSV near the groin
what is the alignment sign?
-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
what is the small saphenous vein (SSV)
-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
what are the perforators?
-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
where are perforators?
-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
what are communicating veins
-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
what are the sural veins (sinusoid or saccular veins) and where are they
-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
what is a soleal plexus/soleal sinus
-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
what are valves and what are their purpose?
-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
