Femoral vein. Veins of the lower limb Veins of the thigh


Anatomy of the venous system lower extremities are highly variable. Knowledge of the individual structural features of the human venous system plays a major role in assessing instrumental examination data in choosing the correct treatment method.

In the venous system of the lower extremities, a deep and superficial network is distinguished.

Deep venous network represented by paired veins accompanying the arteries of the fingers, foot and leg. The anterior and posterior tibial veins merge in the femoropopliteal canal and form the azygos popliteal vein, which passes into the powerful trunk of the femoral vein (v. femoralis). 5-8 perforating veins and the deep vein of the thigh (v. femoralis profunda), which carries blood from the muscles of the back of the thigh, flow into the femoral vein, even before passing into the external iliac vein (v. iliaca externa). The latter, in addition, has direct anastomoses with the external iliac vein (v. iliaca externa), through intermediary veins. In case of occlusion of the femoral vein, part of the femoral vein may flow through the deep vein system into the external iliac vein (v. iliaca externa).

Superficial venous network located in the subcutaneous tissue above the superficial fascia. It is represented by two saphenous veins - the great saphenous vein (v. saphena magna) and the small saphenous vein (v. saphena parva).

Great saphenous vein (v. saphena magna) starts from the internal marginal vein of the foot and along its entire length receives many subcutaneous branches of the superficial network of the thigh and lower leg. In front of the inner ankle, it rises to the lower leg and, going around the back of the inner condyle of the femur, rises to the oval opening in the groin area. At this level it flows into the femoral vein. The great saphenous vein is considered the longest vein in the body, has 5-10 pairs of valves, and its diameter along its entire length ranges from 3 to 5 mm. In some cases, the great saphenous vein of the thigh and leg can be represented by two or even three trunks. 1-8 tributaries flow into the uppermost section of the great saphenous vein, in the groin area; these are often three branches that do not have much practical significance: the external genital (v. pudenda externa super ficialis), superficial epigastric (v. epigastica superficialis) and the superficial vein surrounding the ilium (v. cirkumflexia ilei superficialis).

Small saphenous vein (v. saphena parva) begins from the external marginal vein of the foot, collecting blood mainly from the sole. Rounding the outer ankle from behind, it rises along the middle of the back surface of the lower leg to the popliteal fossa. Starting from the middle of the leg, the small saphenous vein is located between the layers of the fascia of the leg (N.I. Pirogov’s canal) accompanied by the medial cutaneous nerve of the calf. And therefore, varicose veins of the small saphenous vein are much less common than the large saphenous vein. In 25% of cases, the vein in the popliteal fossa passes through the fascia deep and flows into the popliteal vein. In other cases, the small saphenous vein can rise above the popliteal fossa and flow into the femoral, large saphenous vein, or into the deep vein of the thigh. Therefore, before the operation, the surgeon must know exactly where the small saphenous vein flows into the deep one in order to make a targeted incision directly above the anastomosis. Both saphenous veins widely anastomose with each other by direct and indirect anastomoses and are connected through numerous perforating veins with the deep veins of the leg and thigh. (Fig.1).

Fig.1. Anatomy of the venous system of the lower extremities

Perforating (communicating) veins (vv. perforantes) connect deep veins to superficial ones (Fig. 2). Most perforating veins have valves located suprafascially, which allow blood to move from the superficial to the deep veins. There are direct and indirect perforating veins. Direct ones directly connect the main trunks of the superficial and deep veins, indirect ones connect the saphenous veins indirectly, that is, they first flow into the muscular vein, which then flows into the deep vein. Normally they are thin-walled and have a diameter of about 2 mm. If the valves are insufficient, their walls thicken and their diameter increases 2-3 times. Indirect perforating veins predominate. The number of perforating veins on one limb ranges from 20 to 45. In the lower third of the leg, where there are no muscles, direct perforating veins predominate, located along the medial edge of the tibia (Cockett's area). About 50% of the communicating veins of the foot do not have valves, so blood from the foot can flow from deep veins to superficial ones, and vice versa, depending on the functional load and physiological conditions of outflow. In most cases, perforating veins arise from tributaries rather than from the trunk of the great saphenous vein. In 90% of cases, there is incompetence of the perforating veins of the medial surface of the lower third of the leg.

Fig.2. Options for connecting the superficial and deep veins of the lower extremities according to S. Kubik.

1 - leather; 2 - subcutaneous tissue; 3 - superficial fascial leaf; 4 - fibrous bridges; 5 - connective tissue vagina of the saphenous veins; 6 - own fascia of the leg; 7 - saphenous vein; 8 - communicating vein; 9 - direct perforating vein; 10 - indirect perforating vein; 11 - connective tissue sheath of deep vessels; 12 - muscle veins; 13 - deep veins; 14 - deep artery.

Significant variability in the structure of the superficial venous network of the lower extremities is aggravated by discrepancies in the names of veins and the presence of a large number of surnames, especially in the names of perforating veins. To eliminate such discrepancies and create a unified terminology for the veins of the lower extremities, the International Interdisciplinary Consensus on Venous Anatomical Nomenclature was created in 2001 in Rome. According to it, all veins of the lower extremities are conventionally divided into three systems:

1. Superficial veins
2.Deep veins
3. Perforating veins.

Superficial veins lie in the space between the skin and the deep (muscular) fascia. The GSV is located in its own fascial sheath, formed by the splitting of the superficial fascia. The trunk of the SVC is also located in its own fascial sheath, the outer wall of which is a superficial layer of muscular fascia.

Superficial veins provide the outflow of approximately 10% of the blood from the lower extremities. The deep veins are located in spaces deeper than this muscular fascia. In addition, deep veins always accompany arteries of the same name, which does not happen with superficial veins. The deep veins provide the main drainage of blood - 90% of all blood from the lower extremities flows through them. Perforating veins perforate the deep fascia, connecting the superficial and deep veins.

The term “communicating veins” is reserved for veins that connect certain veins of the same system (i.e., either superficial to each other or deep to each other).
Main superficial veins:
1. Great saphenous vein
vena saphena magna, in English literature - great saphenous vein (GSV). Its source is the medial marginal vein of the foot. It goes up the medial surface of the leg and then the thigh. Drained into the BV at the level of the inguinal fold. Has 10-15 valves. The superficial fascia on the thigh splits into two layers, forming a canal for the GSV and cutaneous nerves. This fascial canal is considered by many authors as a protective outer “cover” that protects the GSV trunk from excessive stretching when the pressure in it increases.
On the thigh, the trunk of the GSV and its large tributaries in relation to the fascia can take three main types of relationship:

2. The most constant tributaries of the GSV:
2.1 Intersaphena vein(s) (vena(e)) intersaphena(e) in English literature - intersaphenous vein(s) - runs (run) along the medial surface of approximately the lower leg. Connects the GSV and SSV. Often has connections with perforating veins of the medial surface of the leg.

2.2 Posterior femoral vein(vena circumflexa femoris posterior), in English literature - posterior thigh circumflex vein. It may have its source in the SVC, as well as the lateral venous system. It rises from the back of the thigh, wraps around it, and drains into the GSV.

2.3 Anterior circumflex vein(vena circumflexa femoris anterior), in English literature - anterior thigh circumflex vein. May have its source in the lateral venous system. It rises along the anterior surface of the thigh, wrapping around it, and drains into the GSV.

2.4 Posterior accessory great saphenous vein(vena saphena magna accessoria posterior), in English literature - posterior accessory great saphenous vein (the segment of this vein on the lower leg is called the posterior arched vein or vein of Leonardo). This is the name of any venous segment on the thigh and lower leg that runs parallel and posterior to the GSV.

2.5 Anterior accessory great saphenous vein(vena saphena magna accessoria anterior), in English literature - anterior accessory great saphenous vein. This is the name of any venous segment on the thigh and lower leg that runs parallel and anterior to the GSV.

2.6 Superficial accessory great saphenous vein(vena saphena magna accessoria superficialis), in English literature - superficial accessory great saphenous vein. This is the name of any venous segment on the thigh and lower leg that runs parallel to the GSV and is more superficial relative to its fascial sheath.

2.7 Inguinal venous plexus(confluens venosus subinguinalis), in English literature - confluence of superficial inguinal veins. It is the terminal section of the GSV near the anastomosis with the BV. In addition to the last three tributaries listed, three fairly constant tributaries flow here:
superficial epigastric vein(v.epigastrica superficialis)
external pudendal vein(v.pudenda externa)
superficial vein surrounding the ilium(v. circumflexa ilei superficialis).
In the English-language literature, there is a long-established term Crosse designating this anatomical segment of the GSV with the listed tributaries (this term comes from the resemblance to a lacrosse stick. Lacrosse is a Canadian national game of Indian origin. Players, using a stick with a net at the end (crosse), must catch heavy rubber ball and throw it into the opponent’s goal).

3. Small saphenous vein
vena saphena parva, in English literature - small saphenous vein. It has its source in the external marginal vein of the foot.

It rises along the back surface of the leg and flows into the popliteal vein, most often at the level of the popliteal fold. Receives the following tributaries:

3.1 Superficial accessory small saphenous vein(vena saphena parva accessoria superficialis), in English literature - superficial accessory small saphenous vein. It runs parallel to the trunk of the SVC above the superficial layer of its fascial sheath. It often drains independently into the popliteal vein.

3.2 Cranial continuation of the small saphenous vein(extensio cranialis venae saphenae parvae), in English literature cranial extension of the small saphenous vein. Previously called the femoropopliteal vein (v. femoropoplitea). It is a rudiment of an embryonic intervenous anastomosis. When there is an anastomosis between this vein and the posterior circumferential femoral vein from the GSV system, it is called the vein of Giacomini.

4. Lateral venous system
systema venosa lateralis membri inferioris, in English literature – lateral venous system. Located on the lateral surface of the thigh and lower leg. It is assumed that it is a rudiment of the lateral marginal vein system that existed in the embryonic period.

Of course, only the main clinically significant venous collectors have their own names and are listed. Considering the high diversity of the structure of the superficial venous network, other superficial veins not included here should be named by their anatomical location.

Perforating veins:

1. Perforating veins of the foot

1.1 dorsal perforating veins of the foot

1.2 medial perforating veins of the foot

1.3 lateral perforating veins of the foot

1.4 plantar perforating veins of the foot

2. Perforating veins of the ankle

2.1 medial ankle veins

2.2 anterior perforating veins of the ankle

2.3 lateral perforating veins of the ankle

3. Perforating veins of the leg

3.1 medial perforating veins of the leg

3.1.1 paratibial perforating veins

3.1.2 posterotibial perforating veins

3.2 anterior perforating veins of the leg

3.3 lateral perforating veins of the leg

3.4 posterior perforating veins of the leg

3.4.1 medial gastrocnemius perforating veins

3.4.2 lateral gastrocnemius perforating veins

3.4.3 intercapital perforating veins

3.4.4 paraachillary perforating veins

4. Perforating veins of the knee joint

4.1 medial perforating veins of the knee joint

4.2 suprapatellar perforating veins

4.3 perforating veins of the lateral surface of the knee joint

4.4 subpatellar perforating veins

The main deep veins of the thigh: part of the popliteal vein, femoral vein, deep femoral vein. The popliteal and femoral veins often duplicate to form a plexus (Dodd and Cockett 1956).

The deep femoral vein connects with the femoral vein in two places, the lower connection with the plexus in the adductor canal, and the upper one 5 cm below the inguinal ligament. These veins receive venous branches from surrounding muscles and perforating veins, the largest tributary being the great saphenous vein.

The upper part of the popliteal vein lies on the lateral surface of the popliteal artery, and passing through the m. The adductor magnus becomes the femoral vein. This vessel intersects with the femoral artery behind it from the lateral to the medial border, and passes through the adductor canal and the femoral triangle. The femoral vein can have up to 6 valves, but usually 3. One of them is immediately distal to the junction with the deep bodiline vein, the other just below the inguinal ligament.

Superficial veins of the thigh - the great saphenous vein and its tributaries. The great saphenous vein begins behind the medial femoral condyle and runs in the medial part of the thigh. It deviates slightly anteriorly and connects with the femur 4 cm below and slightly lateral to the pubic tubercle. Its posteromedial branch (tibial accessory saphenous vein) runs along the posterior surface of the thigh, where it often has a connection with the small saphenous vein, connects with the great saphenous vein at the level of the border of the upper and middle third of the thigh, sometimes higher.

The anterolateral branch (peroneal accessory saphenous vein) begins along the lateral surface of the upper leg, sometimes associated with the lateral branch of the small saphenous vein, or the superior peroneal perforating vein. It runs obliquely up the anterolateral surface of the knee, then runs along the anterior surface of the thigh and joins the great saphenous vein at a point midway between the mid-thigh and the opening of the saphenous vein. Three tributaries flow into the great saphenous vein at the mouth - the superficial circumflex iliac vein, the superficial epigastric vein, and the external genital vein.

The average number of valves in the long saphenous vein of the leg is plus a permanent valve at the mouth of the vein. There is almost always another valve 5 cm below the mouth (Cotton 1961).

The most common perforating veins in the thigh connect the great saphenous vein with the femoral vein in the adductor canal or Gunter's canal and are therefore called the superior, middle, and inferior Gunter's perforating veins.

The upper one penetrates through the roof of the adductor canal in its upper part. The middle one is constant, passes behind m. sartorius. The inferior one pierces the deep fascia above the medial femoral condyle and connects to the knee venous plexus.

There are three other perforating veins in the thigh that deserve mention. The two are connected to the anterolateral branch by the great saphenous vein, at the point where it intersects a vertical line from the edge of the patella. This vessel connects with the venous branches of the lateral circumflex vein of the thigh. At the point where the posteromedial venous branch of the great saphenous vein crosses the tendons of the m. semimembranosus and m. semitendinosus, there is often a perforating vein.

All perforating veins of the thigh have valves that allow blood to flow only from the superficial to the deep veins.

The anatomy and projection of the femoral veins helps to understand the structure of the circulatory system. The vascular network provides an approximate diagram, but is variable. Each person has a unique venous pattern. Knowledge of the structure and functions of the vascular system will help you avoid leg diseases.

Anatomical structure and topography of veins

The head center of the circulatory system is the heart. Vessels depart from it, which contract rhythmically and pump blood throughout the body. The fluid quickly flows to the lower extremities through the arteries, and returns steadily through the veins.

Sometimes these two terms are mistakenly confused. But the veins are only responsible for the outflow of blood. There are 2 times more of them than arteries, and the movement here is calmer. Due to the fact that the walls of such vessels are thinner and the location is more superficial, veins are used to collect biomaterial.

The bed of the system is a tube with elastic walls, consisting of reticulin and collagen fibers. Thanks to the unique properties of the fabric, they retain their shape well.

There are three structural layers of the vessel:

  • intima - the inner cover of the cavity located under the protective shell;
  • media - central segment consisting of spiral-shaped, smooth muscles;
  • adventitia - the outer covering in contact with a membrane of muscle tissue.

Between the layers there are elastic partitions: internal and external, creating the boundary of the covers.

The walls of the vessels of the femoral limbs are stronger than in other parts of the body. Strength is determined by the placement of the cores. The channels are embedded in the subcutaneous tissue, so they withstand pressure changes, as well as factors affecting the integrity of the tissue.

Functions of the venous network of the thigh

Features of the structure and location of the venous network of the lower extremities give the system the following functions:

  • The outflow of blood containing cell waste and carbon dioxide molecules.
  • Supply of synthesized glands, hormonal regulators, organic compounds, nutrients from the gastrointestinal tract.
  • Circulation of blood circulation through the valve system, thanks to which movement resists the force of gravity.

With pathologies of the venous vessels, circulatory failures occur. Violations cause stagnation of biomaterial, swelling or deformation of pipes.

Projection of types of femoral veins

Valves occupy an important position in the anatomical projection of the venous system. The elements are responsible for the correct direction, as well as the distribution of blood along the channels of the vascular network.

The veins of the femoral extremities are classified by type:

  • deep;
  • superficial;
  • perforating

Where do the deep vessels pass?

The mesh is laid deep from the skin, between the muscle and bone tissues. The deep vein system runs through the thigh, lower leg, and feet. Up to 90% of the blood flows through the veins.

The vascular network of the lower extremities includes the following veins:

  • genital lower;
  • iliac: external and common;
  • femoral and general femoral;
  • popliteal and paired branches of the lower leg;
  • sural: lateral and medial;
  • fibular and tibial.

The channel begins at the back of the foot with the metatarsal vessels. The fluid then enters the anterior tibial vein. Together with the posterior one, it articulates above the middle of the lower leg, uniting into the popliteal vessel. The blood then enters the popliteal femoral canal. 5–8 perforating branches also converge here, originating from the muscles of the back of the thigh. These include lateral and medial vessels. Above the inguinal ligament, the trunk is supported by the epigastric and deep veins. All tributaries flow into the external iliac vessel, which merges with the internal iliac branch. The channel directs blood to the heart.

The common femoral vein passes through a separate wide trunk, consisting of a lateral, medial, and large saphenous vessel. There are 4–5 valves on the core section that set the correct movement. Sometimes there is a doubling of the common trunk, which closes in the area of ​​the ischial tuberosity.

The venous system runs parallel to the arteries of the leg, foot and toes. By bending around them, the channel creates a duplicate branch.

Layout and tributaries of superficial vessels

The system is laid through the subcutaneous tissue under the epidermis. The bed of the superficial veins originates from the plexuses of blood vessels of the toes. Moving upward, the stream divides into lateral and medial branches. The canals give rise to two main veins:

  • large subcutaneous;
  • small subcutaneous

Great saphenous vein of thigh- the longest vascular branch. There are up to 10 pairs of valves on the mesh, and the maximum diameter reaches 5 mm. In some people, the large vein consists of several trunks.

The vascular system passes through the lower limbs. From the back of the ankle the channel extends to the lower leg. Then, going around the internal condyle of the bone, it rises to the oval opening of the inguinal ligament. The femoral canal originates in this area. Up to 8 tributaries also flow here. The main ones are: the external genital, superficial epigastric and iliac veins.

Small saphenous vein the channel begins on the front side of the foot from the marginal vessel. Curving around the ankle from behind, the branch stretches along the back of the lower leg to the popliteal region. From the middle of the calf, the trunk runs through the connective tissues of the limb in parallel with the medial cutaneous nerve.

Due to the additional fibers, the strength of the vessels increases, so the small vein, unlike the large one, is less likely to undergo varicose veins.

Most often, the vein crosses the popliteal fossa and flows into the deep or great saphenous vein. But in a quarter of cases, the branch penetrates deep into the connective tissue and articulates with the popliteal vessel.

Both surface trunks receive tributaries in different areas in the form of subcutaneous and skin channels. The venous pipes communicate with each other using perforating branches. When surgically treating leg diseases, the doctor needs to accurately determine the anastomosis of the small and deep vein.

Perforator mesh location

The venous system connects the superficial and deep vessels of the thigh, leg, and foot. The branches of the mesh pass through the soft tissues, penetrating the muscles, which is why they are called perforating or communicative. The trunks have a thin wall, and the diameter does not exceed 2 mm. But with a lack of valves, the septum tends to thicken and expand several times.

The perforating mesh is divided into two types of veins:

  • straight;
  • indirect.

The first type connects the tubular trunks directly, and the second - through additional vessels. The mesh of one limb consists of 40–45 threading channels. The system is dominated by indirect branches. The straight lines are concentrated in the lower part of the lower leg, along the edge of the tibia. In 90% of cases, pathologies of perforating veins are diagnosed in this area.

Half of the vessels are equipped with directional valves that send blood from one system to another. The veins of the feet do not have filters, so the outflow here depends on physiological factors.

Indicators of the diameter of venous vessels

The diameter of the tubular element of the lower extremities ranges from 3 to 11 mm depending on the type of vessel:

The diameter of the vessel depends on the muscle tissue located in the area under study. The better developed the fibers, the wider the venous tube.

The indicator is affected by the proper operation of the valves. When the system is disrupted, a jump in blood outflow pressure occurs. Long-term dysfunction leads to deformation of the venous vessels or the formation of clots. Frequently diagnosed pathologies include varicose veins, thrombophlebitis, and thrombosis.

Diseases of the venous vessels

According to WHO, pathologies of the venous system are registered in every tenth adult. The number of young patients is growing every year, and disorders are found in schoolchildren. Diseases of the circulatory system of the lower extremities are most often caused by:

  • overweight;
  • hereditary factor;
  • sedentary lifestyle;

The most common dysfunctions of the venous system of the lower extremities:

Varicose veins are valvular insufficiency, and subsequently deformation of the small or large saphenous veins. It is more often diagnosed in women over 25 years of age who have a genetic predisposition or are overweight.

Superficial veins

Superficial veins of the lower limb, vv. superficiales membri inferioris , anastomose with the deep veins of the lower limb, vv. profundae membri inferioris, the largest of them contain valves.

In the foot area, the saphenous veins (Fig.,) form a dense network, which is divided into plantar venous network, rete venosum plantare, And dorsal venous network of the foot, rete venosum dorsale pedis.

On the plantar surface of the foot, rete venosum plantare receives efferent veins from the network of superficial plantar digital veins, vv. digitales plantares And intercapitate veins, vv. intercapitulares, as well as other veins of the sole, forming arches of different sizes.

The subcutaneous venous plantar arches and superficial veins of the sole along the periphery of the foot widely anastomose with the veins running along the lateral and medial edges of the foot and are part of the cutaneous dorsal venous network of the foot, and also pass in the heel into the veins of the foot and further into the veins of the leg. In the area of ​​​​the edges of the foot, the superficial venous networks turn into lateral marginal vein, v. marginalis lateralis which passes into the small saphenous vein of the leg, and medial marginal vein, v. marginalis medialis, giving rise to the great saphenous vein of the leg. The superficial veins of the sole anastomose with the deep veins.

On the dorsum of the foot in the area of ​​each toe there is a well-developed venous plexus of the nail bed. The veins that drain blood from these plexuses run along the edges of the dorsum of the fingers - these are dorsal digital veins of the foot, vv. digitales dorsales pedis. They anastomose between themselves and the veins of the plantar surface of the fingers, forming at the level of the distal ends of the metatarsal bones dorsal venous arch of the foot, arcus venosus dorsalis pedis. This arch is part of the cutaneous dorsal venous network of the foot. Along the rest of the dorsum of the foot, the feet stand out from this network dorsal metatarsal veins of the foot, vv. metatarsales dorsales pedis, among them are relatively large veins that run along the lateral and medial edges of the foot. These veins collect blood from the dorsal as well as from the plantar venous networks of the foot and, heading proximally, directly continue into two large saphenous veins of the lower limb: the medial vein into the large saphenous vein of the leg, and the lateral vein into the small saphenous vein of the leg.

1. (Fig.; see Fig. , , , ), is formed from the dorsal venous network of the foot, forming as an independent vessel along the medial edge of the latter. It is a direct continuation of the medial marginal vein.

Heading upward, it passes along the anterior edge of the medial malleolus onto the tibia and follows in the subcutaneous tissue along the medial edge of the tibia. Along the way it receives a number of superficial veins of the leg. Having reached the knee joint, the vein bends around the medial condyle from behind and passes to the anteromedial surface of the thigh. Following proximally, it pierces the superficial layer of the lata fascia of the thigh in the area of ​​the subcutaneous fissure and flows into the v. femoralis. The great saphenous vein has several valves.

On the hip v. saphena magna receives numerous veins that collect blood on the anterior surface of the thigh, and the accessory saphenous vein of the leg, v. saphena accessoria, formed from the cutaneous veins of the medial surface of the thigh.

2. Small saphenous vein of the leg, v. saphena parva(see Fig., ), comes out from the lateral part of the subcutaneous dorsal venous network of the foot, forming along its lateral edge, and is a continuation of the lateral marginal vein. Then it goes around the back of the lateral malleolus and, heading upward, passes to the back surface of the leg, where it runs first along the lateral edge of the calcaneal tendon, and then in the middle of the back surface of the leg. On its way, the small saphenous vein, receiving numerous saphenous veins of the lateral and posterior surfaces of the leg, widely anastomoses with the deep veins. In the middle of the back surface of the leg (above the calf) it passes between the layers of the fascia of the leg, runs next to the medial cutaneous nerve of the calf, n. cutaneus surae medialis, between the heads of the gastrocnemius muscle. Having reached the popliteal fossa, the vein goes under the fascia, enters the depth of the fossa and flows into the popliteal vein. The small saphenous vein has several valves.

V. saphena magna and v. saphena parva widely anastomose with each other.

Deep veins

Deep veins of the lower limb, vv. profundae membri inferioris , identical with the arteries that they accompany (Fig.). Begin on the plantar surface of the foot on the sides of each toe plantar digital veins, vv. digitales plantares, accompanying the arteries of the same name. Merging, these veins form plantar metatarsal veins, vv. metatarsales plantares. Perforating veins depart from them, vv. perforantes, which penetrate the dorsum of the foot, where they anastomose with the deep and superficial veins.

Heading proximally, vv. metatarsales plantares flow into plantar venous arch, arcus venosus plantaris. From this arch, blood flows through the lateral plantar veins, which accompany the artery of the same name. The lateral plantar veins connect with the medial plantar veins to form the posterior tibial veins. From the plantar venous arch, blood flows through the deep plantar veins through the first interosseous metatarsal space towards the veins of the dorsum of the foot.

The beginning of the deep veins of the dorsum of the foot are dorsal metatarsal veins of the feet, vv. metatarsales dorsales pedis, which flow into dorsal venous arch of the foot, arcus venosus dorsalis pedis. From this arch the blood flows into the anterior tibial veins, vv. tibiales anteriores.

1. Posterior tibial veins, vv. tibiales posteriores(Fig. , ), paired. They are directed proximally, accompanying the artery of the same name, and receive on their way a number of veins extending from the bones, muscles and fascia of the posterior surface of the leg, including quite large ones peroneal veins, vv. fibulares (peroneae). In the upper third of the leg, the posterior tibial veins merge with the anterior tibial veins and form the popliteal vein, v. poplitea.

2. Anterior tibial veins, vv. tibiales anteriores(see Fig.,), are formed as a result of the fusion of the dorsal metatarsal veins of the foot. Moving to the lower leg, the veins go up along the artery of the same name and penetrate through the interosseous membrane onto the back surface of the lower leg, taking part in the formation of the popliteal vein.

The dorsal metatarsal veins of the foot, anastomosing with the veins of the plantar surface through perforating veins, receive blood not only from these veins, but mainly from the small venous vessels of the ends of the fingers, which, merging, form vv. metatarsales dorsales pedis.

3. Popliteal vein, v. poplitea(Fig.; see Fig.), having entered the popliteal fossa, it goes lateral and posterior to the popliteal artery, the tibial nerve passes superficially and lateral to it, n. tibialis. Following the course of the artery upward, the popliteal vein crosses the popliteal fossa and enters the adductor canal, where it receives the name femoral vein, v. femoralis.), sometimes a steam room, accompanies the artery of the same name in the adductor canal, and then in the femoral triangle, passes under the inguinal ligament in the vascular lacuna, where it becomes v. iliaca externa.

In the adductor canal, the femoral vein is located behind and somewhat lateral to the femoral artery, in the middle third of the thigh - behind it, and in the vascular lacuna - medial to the artery.

The femoral vein receives a number of deep veins that accompany the arteries of the same name. They collect blood from the venous plexuses of the muscles of the anterior surface of the thigh, accompany the femoral artery on the corresponding side and, anastomosing with each other, flow into the femoral vein in the upper third of the thigh.

1) Deep vein of the thigh, v. profunda femoris, most often comes with one barrel, has several valves. The following paired veins flow into it: a) perforating veins, vv. perforantes, go along the arteries of the same name. On the posterior surface of the adductor magnus muscle, they anastomose with each other, as well as with v. glutea inferior, v. circumflexa medialis femoris, v. poplitea; b) medial and lateral veins circumflexing the femur, vv. circumflexae mediales et laterales femoris. The latter accompany the arteries of the same name and anastomose both with each other and with the vv. perforantes, vv. gluteae inferiores, v. obturatoria.

In addition to these veins, the femoral vein receives a number of saphenous veins. Almost all of them approach the femoral vein in the area of ​​the saphenous fissure.

2) Superficial epigastric vein, v. epigastrica superficialis(Fig. ), accompanies the artery of the same name, collects blood from the lower parts of the anterior abdominal wall and flows into v. femoralis or in v. saphena magna. Anastomoses with v. thoracoepigastrica (flows into v. axillaris), vv. epigastricae superiores et inferiores, vv. paraumbilicales, as well as with the vein of the same name on the opposite side.

3) Superficial vein circumflexing the ilium, v. circumflexa superficialis ilium, accompanying the artery of the same name, runs along the inguinal ligament and flows into the femoral vein.

4) External genital veins, vv. pudendae externae, accompany the arteries of the same name. They are actually a continuation anterior scrotal veins, vv. scrotales anteriores(among women - anterior labial veins, vv. labiales anteriores), And superficial dorsal vein of the penis, v. dorsalis superficialis penis(among women - superficial dorsal vein of the clitoris, v. dorsalis superficialis clitoridis).

5) Great saphenous vein of the leg, v. saphena magna, is the largest of all saphenous veins. It drains into the femoral vein. Collects blood from the anteromedial surface of the lower limb (see “Superficial veins”).

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