Major veins and tributaries that drain the upper and lower limbs.
Hey everyone! It's Nicole from Kenhub, and welcome to our tutorial on the main veins of the upper and lower limbs. Today, in our tutorial, we're going to be talking about the names and parts of the veins of the upper and lower limbs with the help of this diagram here. Since veins normally drain from the extremities of the body to the heart, the direction of flow is of course from outside in. However, throughout this tutorial, we'll be looking at the veins against the direction of flow, that is, from the most proximal veins to the most distal veins. But we'll talk a little bit more about that later in the tutorial.
Let's begin with some brief information about a vein and its functions. Veins are the thin-walled vessels responsible for returning blood back to the heart from tissues. They have a series of valves inside them which prevent backward blood flow. Veins can be superficial or deep. Superficial veins run close to the skin in the layer of fats just inferior to the skin surface. These can often be seen through the skin. Deep veins are deeper than the superficial veins often traveling through muscle and other tissues. You can see these a little more clearly on the image of the woman on the right.
In her upper half – her right limb is on our left – show the main superficial veins and their tributaries whereas her left limb – is on our right – shows the major deep veins and their tributaries. In her lower half, the reverse is true. That is the deep veins are on her right which is our left and the superficial veins are on her left which is our right.
We mentioned the term tributaries so let's define that term a little bit further. Veins can be subdivided into tributaries which flow into more proximal veins much like the tributaries of a river flowing out to the sea. Remember, veins drain from the periphery of the body to the center. As the veins flow from the peripheries, the tributaries grow in size until they reach the larger veins of the heart.
So now that you know a little more about veins and their tributaries, let's have a closer look at the veins of the upper limb.
As we mentioned earlier, in spite of the direction of blood traveling from the periphery to the center, in this tutorial, we're going to work from the center to the periphery against the flow of blood. Looking at the veins this way, the major veins can therefore be divided into several sections – the deep veins of the arm which include the subclavian vein, the axillary vein and the brachial vein; the superficial veins of the arm which include the cephalic vein and the basilic vein; the veins of the forearm which include the radial vein and the ulnar vein; and the veins of the hand which can be divided into the dorsal venous network and the two palmar arches – one deep and one superficial.
Let's of course begin with the veins of the arm.
The subclavian vein is formed where the cephalic vein meets the axillary vein at the outer border of the first rib and drains almost all of the blood of the arm. From there, it runs towards the midline of the body and joins the internal jugular vein just below the base of the neck to form the brachiocephalic vein. This drains into the superior vena cava acronymed SVC which returns the blood to the heart.
The axillary vein is formed by the confluence of the deep brachial vein and the superficial basilic vein around about the level of the lower margin of the teres major. It merges with the cephalic vein at the outer border of the first rib to form the subclavian vein. The axillary vein drains the blood from these veins as well as some of the upper outer chest wall and the shoulder blade.
The brachial vein is formed by the radial vein and the ulnar vein at the elbow. A deep vein, it runs up the middle of the arm in front of the bones. As mentioned in the previous slide, the brachial vein merges with the basilic vein to form the axillary vein. The brachial vein drains the radial and ulnar veins as well as small branches from the upper arm muscles such as the biceps brachii and triceps brachii.
Now that we finished talking about the deep veins of the arm, let's talk about the superficial veins of the arm.
The basilic vein as we mentioned earlier is a superficial vein. It is not formed from any smaller tributaries; instead arising from the ulnar side of the dorsal venous network of the hand. It then travels from the ulnar side of the hand up the medial side of the upper limb to its junction with the brachial vein at the shoulder where it forms the axillary vein. The basilic vein drains the hand and medial aspect of the upper limb.
Moving superiorly up the body a little, the cephalic vein is a superficial vein running the full length of the upper limb. The cephalic vein arises from the radial border of the dorsal venous network of the hand. It then travels from the radial side of the hand up the lateral side of the arm to the clavicle where it merges with the axillary vein to become the subclavian vein. It drains the hand and the lateral aspect of the upper limb. Due to its superficial nature, the cephalic vein can be used for blood taking in a clinical setting.
The median cubital vein is a superficial vein located in the cubital fossa. It receives some blood from the cephalic vein which it then contributes to the basilic vein. The median cubital vein is the main site for venepuncture.
Now that we finished talking about the veins that are found mainly in the arm, let's talk about the veins that are found mainly in the forearm.
Moving down the forearm, we can see the radial vein highlighted in green on our right. The radial vein is a deep vein, one of two in the forearm. It arises from the deep anastomosing veins of the hand and wrist and follows the path of the radial artery which is located on the radial side of the forearm. The radial vein merges with the ulnar vein to form the brachial vein at the elbow. The radial vein drains the deep palmar venous arches which we'll discuss in more detail later on.
The ulnar vein – highlighted in green – is the other deep vein of the forearm. The ulnar vein arises from the superficial palmar arch and like the radial veins follows the path of the ulnar artery deep in the ulnar side of the forearm. Along with the radial vein, it forms the brachial vein at the elbow and drains the superficial palmar venous arches.
Now that we finished talking about the veins that are mainly found in the forearm, let's talk about the veins of the hand.
As we mentioned at the beginning of the tutorial, the hand is drained through the veins in the dorsum of the hand, the dorsal venous network, and in the palm is drained by the palmar venous arches. Let's start with the dorsal venous network.
The dorsal venous network of the hand arises from the dorsal digital veins and the dorsal metacarpal veins draining the blood from the dorsal aspect of the hand and finger. This blood then drains into the superficial veins of the forearm – that is, the cephalic vein and the basilic vein.
There are two palmar venous arches of the hand – the superficial palmar venous arch and the deep palmar venous arch. The superficial palmar venous arch mostly drains the palmar digital veins which are the more distal veins in the hand and communicates with the deep palmar venous arch. The deep palmar venous arch mostly drains the palmar metacarpal veins. These are the more proximal veins in the hand. The arch communicates with the dorsal venous network. Both drain to the deep veins of the forearm – that is, the ulnar vein and the radial vein.
We’ve now finished the veins at the upper limb. Feel free to take a break if you need to and then we'll get started on the veins of the lower limb.
Like the upper limb veins, there are superficial and deep veins in the lower limb. If you recall from our introduction, our image on the right here shows the superficial veins on the woman's left leg which is over here on our right and the deep veins on her right leg which is over here on our left. As for the upper limb, we'll go against the direction of venous blood flow proximal to distal and deep to superficial. So as you can see, we'll be starting with the veins of the leg which include the femoral vein and the popliteal vein followed by the deep veins of the calf which include the anterior tibial vein, the posterior tibial vein and the fibular vein; the superficial veins of the calf come next with the great saphenous vein and the small saphenous vein; and lastly we'll finish with the veins of the foot which include the dorsal venous arch of the foot and the plantar venous network of the foot.
Let's of course begin with the veins of the leg.
As with the subclavian vein to the upper limb, the femoral vein is a deep vein. Its course takes it up the center of the thigh superficial to the femur. The femoral vein is a continuation of the popliteal vein just above the knee. The femoral vein is joined by the great saphenous vein just below the inguinal ligament and the veins of the thigh. After it passes under the inguinal ligament, the femoral vein forms the external iliac vein which itself then joins the internal iliac vein to become the common iliac vein. This flows into the inferior vena cava, acronymed IVC which carries the blood back to the heart. The femoral vein drains almost all the blood from the lower limb.
Moving downwards, we find the popliteal vein. The popliteal vein is a deep vein which is continuous with the femoral vein. It is the name given to the lowest section of the femoral vein as it passes through the popliteal fossa – the area behind the knee. The popliteal vein is formed by the combination of the anterior tibial vein, the posterior tibial vein, and the fibular vein. This junction is just below the knee. The popliteal vein drains the superficial and deep structures of the calf and the sole of the foot. It also helps drain the top of the foot.
Now that we finished talking about the veins of the leg, let's now talk about the veins of the calf. We'll start by talking about the deep veins.
As you may remember from our overview earlier in the tutorial, there are three deep veins of the calf. The first of these is the anterior tibial vein. The anterior tibial vein runs in front of the tibia to contribute to the popliteal vein just below the knee. Despite it being a deep vein, it helps drain the superficial blood from the top of the foot via the dorsal venous arch of the foot.
The posterior tibial vein is another deep vein of the calf. This vein is analogous to the anterior tibial vein in the back of the leg. It runs behind the tibia and also contributes to the popliteal vein. The posterior tibial vein drains the plantar venous network of the foot, that is, the veins of the sole of the foot and the calf muscles.
The third deep vein of the calf is the fibular vein also known as the peroneal vein traveling lateral to the fibula – so on the lateral side of the leg – it joins the anterior and the posterior tibial veins to form the vein found at the border of the popliteus muscle, the popliteal vein. The vein assists the posterior tibial vein in draining the plantar venous network of the foot and the calf muscles.
Now that we finished talking about the veins at the leg, let's now take a look at the superficial veins of the calf.
The great saphenous vein is a large superficial vein. Arising from the big toe, it travels in front of the medial malleolus then runs the full length of the medial aspect of the lower limb. The great saphenous vein receives blood from the great toe, the dorsal venous arch of the foot and the superficial structures of the medial lower limb. It flows into the femoral vein just below the inguinal ligament. This is called the saphenofemoral junction.
The small saphenous vein is our second superficial vein. It arises from the little toe, travels along the lateral side of the sole of the foot and wraps behind the lateral malleolus. From there, it travels up the posterior aspect of the calf passing between the two heads of the gastrocnemius otherwise known as the big calf muscle. Note that in this image of the small saphenous vein, its origin is not visible but we can imagine it running along the gastrocnemius just here. The small saphenous vein drains the little toe, the dorsal venous arch of the foot and the skin of the leg. The small saphenous vein and the great saphenous vein are connected by many small veins throughout the calf. The small saphenous vein joins the popliteal vein at the popliteal fossa.
Now that we finished discussing the veins of the calf, let's talk about the veins of the foot.
The dorsal venous arch of the foot is a superficial structure similar to the superficial palmar venous arch of the hand we talked about earlier. It overlies the metatarsal bones and communicates with the plantar venous network. The majority of its job is to drain the dorsal metatarsal veins and the dorsal digital veins of the foot. After receiving blood from these structures, the dorsal venous arch then forms the great saphenous vein on the medial side, the short saphenous vein on the lateral side and the anterior tibial vein somewhere in the middle. In this image of the inferior or plantar side of the foot, you can see the plantar venous network colored in blue. The plantar venous network unlike the dorsal venous network is a network of deep veins with an accompanying deep plantar venous arch. These veins communicate with the dorsal venous arch but their main role is to drain the plantar metatarsal veins and plantar digital veins of the foot. The network form two main plantar veins – one medial and one lateral. These in turn drain mostly into the posterior tibial vein with help from the fibular vein.
Now that we've reached the end of the tutorial, let's have a brief discussion on some of the clinical scenarios related to the veins of the upper and lower limbs. Deep vein thrombosis known more commonly by its acronym, DVT, is a condition whereby blood clots in the deep veins. In this image, the clot is in the popliteal vein highlighted in green. A person is more susceptible to this condition if there has been a diagnosis of cancer or the patient has been sitting immobile for a long period of time, for example, being on a long haul flight. People with a tendency for their blood to clot more readily – that is, hypercoagulability – are also susceptible to clotting. DVTs usually occur in the lower limbs.
Understanding the etiology of DVTs is important as they could be life-threatening. In many cases, a part of the clot in the deep vein can break up and be carried in the bloodstream back to the heart to trigger a pulmonary embolism. Treatment of DVTs usually involves the use of anticoagulants such as warfarin or heparin. These drugs are also known as blood thinners and are usually used as preventative measures. Larger clots – clots that put the patient at risk from a pulmonary embolism or clots that are found in the arm – are usually treated with a thrombolytic agent inserted directly into the vein via a catheter. Many serious DVTs will require a surgery such as venous thrombectomy.
Now that we've reached the end of the tutorial, let's have a brief look back over what we've discussed today.
If you remember, in the first half of the tutorial, we discussed the deep veins of the arm which include the subclavian vein, the axillary vein and the brachial vein; the superficial veins of the arm which include the cephalic vein and the basilic vein; the veins of the forearm which include the radial vein and the ulnar vein; and the veins of the hand which can be divided into the dorsal venous network and the two palmar arches – one deep and one superficial. In the lower half of the body, we discussed the veins of the leg which include the femoral vein and the popliteal vein as well as the deep veins of the calf, the anterior tibial vein, the posterior tibial vein and the fibular vein. We also discussed the superficial veins of the calf which include the great saphenous vein and the small saphenous vein and the veins of the foot which include the dorsal venous arch of the foot and the plantar venous network of the foot. At the end of the tutorial, we also discussed deep vein thrombosis which are blood clots in the veins.
That's it for today everyone. Thanks for watching this Kenhub tutorial!
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