Author: Charlotte O'Leary BSc, MBChB•Reviewer: Dimitrios Mytilinaios MD, PhDLast reviewed: September 14, 2021Reading time: 12 minutes


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The lower limb consists of 2 main kinds of veins:

Superficial veinsDeep veins

The superficial veins are situated within the subcutaneous tworry whilst the deep veins are uncovered deep to the deep fascia. The deep veins acfirm the major arteries and also their branches and also are typically paired.

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They are located within a vascular sheath through the corresponding artery, which helps compush and move blood within the veins. Both types of veins contain venous valves, to proccasion reflux of blood distally, but they are more numerous in the deep veins. They additionally contain tributaries, other veins which drainpipe into them.

Key facts about the veins of the lower limb
Superficial veinsGreat saphenous vein (lengthy saphenous vein)Small saphenous vein (short saphenous vein)
Deep veinsVeins of the foot- plantar veins- dorsal veinsVeins of the leg- anterior tibial veins- posterior tibial veins- fibular veinsVeins of the knee- popliteal veinVeins of the thigh- feethical vein and also its tributaries
Clinical relationsVaricose veins, venous thromboembolism, grafting for bypass

This article will comment on the anatomy and also tributaries of the veins of the reduced limb in information, complied with by any kind of associated clinical notes.


Contents
Superficial veins of the reduced limbDeep veins of the lower limb Clinical notes
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The lengthy saphenous vein is likewise referred to as the good saphenous vein and is the longest vein in the human body. It is a extension of the medial marginal vein of the foot and also ends in the feethical vein, distal to the inguinal ligament.

It ascends superficial to the medial malleolus, before crossing the distal third of the tibia anteroposteriorly. It passes behind the medial tibial and also feethical condyles before ascfinishing up the medial element of the thigh and passing with the saphenous opening, an aperture in the fascia lata of the thigh. It opens up into the feethical vein 2.5 – 3.5 cm inferolateral to the pubic tubercle. The lengthy saphenous vein is accompanied by branches of the medial feethical cutaneous nerve throughout its course in the thigh. It contains 10-20 venous valves, which are even more numerous within the leg.

Key facts about the lengthy saphenous vein
SourceMedial marginal vein of the foot
TributariesPosteromedial vein of the thighAnterior femoral cutaneous veinSuperficial epigastric veinSuperficial circumflex iliac veinSuperficial exterior pudendal veinDeep outside pudendal vein
Drains toFeethical vein

The lengthy saphenous vein has actually many kind of relations via the short saphenous vein and also the deep veins of the reduced limb through perforating veins. Just distal to the knee, the lengthy saphenous vein communicates and also receives blood from the little saphenous vein, anterior and also posterior tibial veins. The main tributaries of the long saphenous vein join it in the thigh, close to its junction through the feethical vein. There are six of such tributaries

Posteromedial vein of the thigh (accessory vein of the thigh) - drains the superficial element of the posteromedial area of the thighAnterior feethical cutaneous vein - a extension of anterior veins in the distal thigh; it crosses the feethical triangle prior to opening into the long saphenous veinSuperficial epigastric vein - drains the inferior abdominal wall and also opens right into the lengthy saphenous vein as it traverses the saphenous openingSuperficial circumflex iliac vein - also drains the inferior abdominal wall and also opens into the lengthy saphenous vein as it passes through the saphenous openingSuperficial exterior pudendal vein - drains part of the scrotum or labia, and additionally opens into the long saphenous vein at the saphenous openingDeep exterior pudendal vein - also joins the lengthy saphenous vein at the saphenous opening

Flashcards would certainly be the perfect means to revise every one of these veins. Find out exactly how you can make your own!

Quick saphenous vein


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The short saphenous vein, additionally referred to as the small saphenous vein, is a extension of the lateral marginal vein. It passes lateral to the calcaneal tendon and ascends in between the superficial and deep fascia in the distal third of the calf. At the midline of the calf, it penetprices the deep fascia prior to ascfinishing superficial to the gastrocnemius muscle.

At the junction of the intermediate and also proximal thirds of the calf, the brief saphenous vein emerges above the deep fascia prior to passing in between the heads of the gastrocnemius muscle. It terminates in the popliteal vein within the popliteal fossa, 3- 7.5 cm above the knee joint.

Key facts about the short saphenous vein
SourceLateral marginal vein of the foot
TributariesDeep veins of the dorsum of the footCutaneous veins of the leg
Drains toPopliteal vein

The brief saphenous vein has 7-13 valves and also lies near the sural nerve within the leg. On the doramount of the foot, deep veins drain right into the brief saphenous vein and within the leg, it receives many type of cutaneous tributaries. It has actually many kind of branches, which communicate with the lengthy saphenous vein.

If you desire to visualize the veins and understand also them even much better, take advantage of the videos, illustrations and also quizzes contained in the adhering to examine unist:


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Key veins of the upper limb Explore examine unit
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Veins of the reduced extremity Start quiz

Deep veins of the lower limb

The deep veins of the reduced limb have the right to be separated into four primary groups, according to their location:

Veins of the footVeins of the legVein of the kneeVeins of the thigh

Veins of the foot

The foot is composed of two major forms of deep veins:

Plantar veins, which drain the plantar surchallenge or underside of the footDorsal veins, which drain the dorsal or top surface of the foot

Venous plexoffers within the plantar areas of the toes sign up with to form plantar digital veins. These veins affix with their dorsal counterparts, the dorsal digital veins, to form 4 plantar metatarsal veins. These veins run proximally within the intermetatarsal spaces and also then continue on to develop the deep plantar venous arch. Medial and also lateral plantar veins aclimb from this arch.

A dorsal venous arch is likewise current and also is developed by the dorsal metatarsal veins, which are also created by the dorsal and also plantar digital veins.

Veins of the leg


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The anterior tibial veins are created by the venae comitantes, or companion veins, of the dorsalis pedis artery.

The posterior tibial veins are created by the medial and also lateral plantar veins and also accompany the posterior tibial artery. Veins from the calf muscles drain right into posterior tibial veins. They also obtain relations from the superficial veins and the fibular veins.

The fibular veins are additionally formed by the medial and also lateral plantar veins and run with the fibular artery. They obtain tributaries from superficial veins and veins draining the soleus muscle.

Vein of the knee

The popliteal vein is situated within the popliteal fossa and also pierces the adductor magnus muscle, wbelow it becomes the femoral vein. Distally it is medial to the popliteal artery. Between the two heads of the gastrocnemius muscle it is superficial to it and proximally it is posterolateral to it.

The popliteal vein normally has actually 4 or 5 valves and many kind of tributaries. All of the three main veins of the leg drain into it, as well as the short saphenous vein and two muscular veins from each head of the gastrocnemius muscle.

Veins of the thigh


The feethical vein is a extension of the popliteal vein and acproviders the feethical artery. It starts at the opening of the adductor magnus muscle and ends posterior to the inguinal ligament as the outside iliac vein.

Its connection to the feethical artery is variable. Within the distal adductor canal, it is situated posterolateral to the artery, whilst in the proximal canal and also in the apex of the femoral triangle, it lies posterior to the artery. Within the base of the feethical triangle, it is found medial to the feethical artery. It is consisted of within the middle compartment of the feethical sheath and also generally has 4 or 5 valves.

Key facts around the femoral vein
SourcePopliteal vein
TributariesMedial circumflex veinLateral circumflex veinLong saphenous veinProfunda femoris vein
Drains toExternal iliac vein

Tributaries of the feethical vein include:

the medial circumflex veinlateral circumflex veinlong saphenous veinprofunda femoris vein, which drains 4-12 cm distal to the inguinal ligament.

The profunda femoris vein, additionally referred to as the deep vein of the thigh, is situated superficial to the profunda femoris artery. Veins accompanying the perforating branches of the profunda femoris artery drainpipe the thigh muscles and also empty into the profunda femoris vein. The medial and lateral circumflex veins are sometimes tributaries of the profunda femoris vein.


Clinical notes

Varicose veins

Varicose veins are prevalent in the lengthy saphenous vein and its tributaries and also show up because of venous insufficiency. This occurs when the valves come to be inknowledgeable, resulting in retrograde flow of blood within the veins. This outcomes in dilated and tortuous veins. Symptoms include:

tenderness exercise intolerance oedema pruritis (itch)

Treatment involves injection of a sclerosing agent, which breaks dvery own the endothelial wall of the vein. Following therapy and also for prevention of further varicose veins, compression stocmonarchs are recommfinished.

Venous thromboembolism

Venous thromboembolism (VTE) is a blood clotting condition that can manifest as deep vein thrombosis (DVT) or a pulmonary embolism (PE). Three determinants, recognized as Virchow’s triad, are crucial in the breakthrough of a venous thrombosis. They are:

Venous stasis Activation of blood coagulation Vein damage

DVTs are prevalent in the deep veins of the lower limb and also symptoms include oedema, tenderness and also erythema (redness). Diagnosis of a DVT involves the utilisation of the Wells Score, which predicts the probcapability of a DVT. Points are assigned for symptoms such as current surgical procedure, tenderness and also oedema, among others, and a score greater than or equal to 3 suggests a high probcapacity of a DVT. Treatment involves anticoagulation through pharmocotherapeutic agents such as heparin, warfarin and variable Xa inhibitors. Compression stocemperors are provided as a preventative strategy.

Pulmonary embolism (PE) is a very significant complication of DVT in the reduced limb, which can bring about fatality if a primary pulmonary artery is obstructed. It occurs once a thrombus within a deep vein embolises and also travels to the lungs using the inferior vena cava and the appropriate atrium. Classical symptoms encompass chest pain and shortness of breath. However before, PE might current acommonly with symptoms such as seizures, syncope (fainting), haemoptysis (coughing up blood) and fever before. Treatment through anticoagulation is important and also might likewise involve thrombolytic treatment via agents such as alteplase.

Grafting for bypass

The lengthy saphenous vein is generally harvested in order to bypass an obstructed coronary artery. The bypass surgery is referred to as a coronary artery bypass and as soon as harvested the vein is referred to as a graft. It is typically offered as it is easily available and its removal is not problematic because of other collateral circulations in the reduced limb. Before the vein is supplied as a bypass it is reversed, so the valves do not occlude blood circulation in the graft.


Sources

References:

K.L. Moore, A.F. Dalley, A.M.R. Agur: Clinically Oriented Anatomy, 5th Edition, Lippincott Williams & Wilkins (2006), p. 580-3.S. Standring: Gray’s Anatomy The Anatomical Basis Of Clinical Practice, 40th Edition, Elsevier Health Sciences UK (2008), p. 2503, 2565, 2598, 2657.

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