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Veins and tributaries of the lower extremity.
Hey everyone! It's Nicole from Kenhub, and in this tutorial, we're going to be looking at some of the veins that drain blood from the lower limbs.
So in this image, we can see the venous system of the body, and in this tutorial, we’re going to be focusing on the lower half. Let’s start by listing the three types of veins that we can find in the lower limb. The first type of vein we can find are the deep veins, which are usually larger and found deep to the fascia. They are usually paired with arteries like we see represented here, and they’re responsible for a majority – around about eighty five percent – of venous return from the lower limbs.
The superficial veins are usually smaller and found superficial to the fascia, and you can see an example just here. They’re usually unpaired and they’re responsible for about fifteen percent of venous return from the lower limbs. Last, we have the perforating veins which connect the deep and superficial veins and run through fascia which is shown in the image.
Now, let’s get into some more specific anatomy, starting with the deep veins.
So we’re going to begin at the bottom of the foot, and remember blood flows towards the heart through the veins. So, in the case of the lower limbs, it’s always going to be from the feet up, so we’re starting at the beginning in a way. And the aspect of the foot that we’re going to be looking at is also called the plantar aspect which you can see in this image. And just note that the images we’ll be looking at will mainly be the right foot, so this side will be our medial side and this side will be our lateral side.
So, in this image, we can see the plantar metatarsal veins and arteries which are on the sole of the foot, and the plantar metatarsal veins run along with the arteries here which you can see in red. The plantar metatarsal veins arise from the plantar digital veins at the toes and communicate with the veins of the dorsum or the top of the foot. The plantar metatarsal veins run medially within the intermetatarsal spaces which you can see outlined in blue in this image, and they’re also running medial to the artery. The veins then continue onwards to form the deep plantar venous arch which we see here. And note that the medial and lateral plantar veins arise from this arch.
So, let’s continue to the veins found on the dorsal or the top surface of the foot, and we can see the dorsal metatarsal veins in this image just here. And these veins drain the metatarsals on the superior surface of the foot which are highlighted in blue. The dorsal metatarsal veins arise from the dorsal digital veins of the toes and help form the dorsal venous arch.
The next vein we’re going to be looking at is the fibular vein, and this is a paired vein that accompanies the fibular artery which we can see here along the posterolateral region of the lower leg and medial to the posterior aspect of the fibula, which is this bone just here. And these veins receive tributaries from the veins that drain the soleus muscle on the back of the lower leg and from the superficial veins of this part of the body.
The posterior tibial veins are also deep veins of the lower leg that are formed by the medial and lateral plantar veins which we mentioned earlier that emerged from the plantar venous arch. The posterior tibial veins accompany the posterior tibial artery, posterior to the tibia as you would guess, and they received tributaries from the veins of the calf muscles, some superficial veins, and from the fibular veins.
The next deep veins we see here are the anterior tibial veins also located in the lower leg but anterior to the tibia, and they are formed by the venae comitantes of the dorsalis pedis artery. In other words, the anterior tibial veins are formed by the veins that accompany the dorsalis pedis artery of the top of the foot, and the anterior tibial veins drain into the popliteal vein which we’ll look at next.
Here we see the popliteal vein which is located behind the knee within the popliteal fossa, and the popliteal vein receives many tributaries from veins corresponding to the popliteal artery, including the small saphenous vein and two veins from each head of the gastrocnemius muscle. In addition, it also receives the sural veins as the genicular veins. These veins sits between the two heads of the gastrocnemius muscle, and the vein also pierces the adductor magnus muscle traveling superiorly, and at this point, it becomes the femoral vein which we’ll look at next.
And the femoral vein begins at the opening of the adductor magnus muscle, as you can see in this image here, and ends as the external iliac vein, posterior to the inguinal ligament here. As we mentioned before, the femoral vein is the continuation of the popliteal vein of the lower leg. This large deep vein receives many tributaries from the medial and lateral circumflex femoral veins, the great saphenous vein, and from the deep femoral vein. As I mentioned earlier, the deep veins of the lower limb usually accompany the corresponding arteries and the femoral and deep femoral veins accompany the femoral and deep femoral arteries respectively.
Alright, so we’ve traveled through the deep veins from the bottom of the foot to the hip, and we’re now ready to look at the superficial veins of the lower limb, starting with the foot.
And the veins of the foot can be divided into dorsal veins on the top of the foot and plantar veins on the bottom of the foot. The dorsal venous network of the foot is an example of superficial veins found on the upper surface of the foot and this network drains into the great saphenous vein medially and into the small saphenous vein and the anterior tibial veins laterally.
On the plantar aspect of the foot is another network of veins known as the plantar venous network, and this network is also superficially located and it mainly drains into the medial and lateral marginal veins. Other veins found in the foot include the dorsal venous arch of the foot which receives the metatarsal veins of the foot and is relatively easy to palpate and visualize on a bare foot, and the plantar venous arch of the foot which is formed by the superficial veins of the sole of the foot and accompanies the arterial plantar arch. The arteries of the foot are accompanied by veins of the same name even for the superficial veins.
And now let’s follow the veins upward again towards the lower leg. The small saphenous vein is also sometimes referred to as the short saphenous vein, and this vein is a continuation of the lateral marginal vein which we mentioned before. It descends between the superficial and deep fascia in the distal third of the calf, and it penetrates the deep fascia at the midline of the calf before ascending superficially to the gastrocnemius muscle and eventually terminates in the popliteal vein within the popliteal fossa which we looked at before and we can see here.
The small saphenous vein has many branches which communicate with the great saphenous vein which we’ll look at now. The great saphenous vein sometimes referred to as the long saphenous vein, is the longest vein in the human body as we can see it here. This vein is a continuation of the medial marginal vein of the foot and ends distal to the inguinal ligament of the femoral vein.
The great saphenous vein almost twists around the leg as it descends superficial to the medial malleolus, crosses the distal third of the tibia anteroposterolaterally, passes behind the medial tibial and femoral condyles, and then ascends up the medial aspect of the thigh. It then passes through the saphenous opening and opens into the femoral vein, joining the veins of the lower leg into one. Along its course, the great saphenous vein is accompanied by branches of the medial femoral cutaneous nerve and receives several tributaries from all the veins of the leg including from the tibial malleolar region and from the calf.
Many perforating veins connect the great and small saphenous veins to the deep veins along this path, and as we mentioned on the last slide, the great saphenous vein drains into the femoral vein which is the end of the lower limb and the beginning of the abdomen.
So, we followed the deep and superficial veins from the bottom of the foot all the way up to the inguinal canal now, and you can understand the long distance that blood must travel against gravity to get back to the heart. So this is accounted for by the force of a pumping heart as well as the presence of valves in the veins and these valves close when the blood starts to flow backward which helps the blood continue proximally to the heart more successfully with each heartbeat. However, the valves in these veins can become incompetent which results in retrograde flow of blood within the veins, and this means that the valves are no longer able to ensure that the blood flows only in one direction so a backwards or reverse flow occurs. And we see this demonstrated in this image. So, an open valve allows for blood flow, and a properly closed valve helps to continue this blood flow in the correct direction.
A pulley closed valve results in the reverse flow and causes problems to the vein. This results in dilation and torsion of the veins which you can usually see on the surface of the skin. And this condition usually occurs in the veins of the lower limb such as the long saphenous vein and its tributaries.
Varicose veins can be tender to the touch, itchy, and can result in muscle cramps and even swelling in the lower limbs. This condition, however, can be treated by the use of compression stockings and regular exercise in cases where it is not so severe. However, other cases may require endothelial ablation of the veins, sclerotherapy which involves supplying a sclerosing agent to break down the endothelial wall of the vein, or even surgical removal of the vein altogether.
So, before we end this tutorial, I’d like to go through a quick summary of what we’ve learned today.
The veins of the lower limb include deep and superficial veins as well as perforating veins that connects the two types together and travel through fascia. Deep veins of the lower limbs are paired and run alongside their corresponding arteries whereas most superficial veins do not. The veins of the foot are unique in this respect. Veins of the lower limb run from the feet to the hips and drain proximally. So, the feet drain into lower legs which drain into the legs, and it’s helpful to remember the parts of these veins by tracking which muscles they go through or run near.
We also talked about the veins in their divisions so for the deep veins, we talked about the plantar metatarsal veins which flow into the deep plantar venous arch and the medial and lateral plantar veins. We also talked about the dorsal metatarsal veins which went onwards to flow into the dorsal venous arch and we also talked about the fibular vein, the posterior tibial vein, the anterior tibial vein, the popliteal vein, and the femoral vein.
With regards to the superficial veins, we talked about the small saphenous vein and the great saphenous vein. And finally, we talked about varicose veins in our clinical section.
So, thanks for sticking with me throughout this tutorial. That’s all we have time for today. So, this brings us to the end of this tutorial on the veins of the lower limb. I hope you enjoyed this tutorial. Thanks for watching and happy studying!