Veins : Lower Limb

By:-Archan DivitiGroup-1

Veins In the circulatory system, veins are blood

vessels that carry blood toward the heart. Most veins carry deoxygenated blood from the

tissues back to the heart; exceptions are the pulmonary and umbilical veins.

Veins differ from arteries in structure and function; for example, arteries are more muscular than veins, veins are often closer to the skin and contain valves to help keep blood flowing toward the heart, while arteries carry blood away from the heart.

Anatomy:• The thick outermost layer of a

vein is made of connective tissue, called tunica adventitia or tunica externa.

• There is a middle thin layer of bands of smooth muscle called tunica media.

• The interior is lined with endothelial cells called tunica intima.

Classification

• Superficial veins are those whose course is close to the surface of the body, and have no corresponding arteries.

• Deep veins are deeper in the body and have corresponding arteries.

• Communicating veins (or perforator veins) are veins that directly connect superficial veins to deep veins.

Eg:-Giacomini vein.• Pulmonary veins are a set of veins that deliver

oxygenated blood from the lungs to the heart.• Systemic veins drain the tissues of the body and

deliver deoxygenated blood to the heart.

Veins of Lower Limb

SuperficialVeins

DeepVeins

PerforatingVeins

Greater Saphenous

Vein

Small Saphenous

Vein

Femoral Vein

Profunda Femoris

Vein

Popliteal Vein

Peroneal Vein

Anterior &

Posterior Tibial Vein

Femoral Vein• The femoral vein is a blood

vessel that accompanies the femoral artery in the femoral sheath.

• It begins at the adductor canal (also known as Hunter's canal) and is a continuation of the popliteal vein.

• It ends at the inferior margin of the inguinal ligament, where it becomes the external iliac vein.

DrainageSeveral large veins drain into the

femoral vein:• Popliteal vein• Profunda femoris vein• Great saphenous vein

Femoral Vein

Profunda femoris vein• Profunda femoris

vein (or deep femoral vein) is a large deep vein in the thigh.

• It receives blood from the inner thigh and proceeds superiorly and medially running alongside the profunda femoris artery to join with the femoral vein approximately at the level of the inferior-most portion of the ischial tuberosity.

Femoral vein

Popliteal vein• The popliteal vein is located behind

the knee. Its course runs alongside the popliteal artery, but carries the blood from the knee joint and muscles in the thigh and calf back to the heart.

• Its origin is defined by the junction of the posterior tibial vein and anterior tibial vein.

• It drains the peroneal vein before reaching the knee joint and turns into the femoral vein when leaving the adductor canal.

• The popliteal artery extends from the femoral artery behind the popliteal fossa which is the space behind the knee.

Peroneal Vein• The fibular veins (also known as

the peroneal veins).• The fibular veins are deep

veins that help carry blood from the lateral compartment of the leg.

• They drain into the posterior tibial veins, which will in turn drain into the popliteal vein.

• The fibular veins accompany the fibular artery.

Anterior tibial vein• The anterior tibial vein of

the lower limb carries blood from the anterior compartment of the leg to the popliteal vein which is formed when it joins with the posterior tibial vein.

• The anterior tibial vein is accompanied by an anterior tibial artery.

AnteriorTibial Vein

Posterior Tibial vein• The posterior tibial

vein of the lower limb carries blood from the posterior compartment and plantar surface of the foot to the popliteal vein which it forms when it joins with the anterior tibial vein.

• The posterior tibial vein is accompanied by posterior tibial artery. Posterior

Tibial Vein

Clinical Case:Deep Vein Thrombosis• DVT is the formation of a blood

clot in a deep vein, predominantly in the legs.

• DVT usually occurs in a deep leg vein, a larger vein that runs through the muscles of the thigh. It can cause pain and swelling in the leg and may lead to complications such as pulmonary embolism.

• DVT and pulmonary embolism together are known as venous thromboembolism (VTE).

Signs and Symptoms Common signs and symptoms of DVT include

pain, swelling, warmth, redness or discoloration, and distention of surface veins, although about half of those with the condition have no symptoms.

Symptoms are more often due to other causes, such as cellulitis, Baker's cyst, musculoskeletal injury, or lymphedema.

Other differential diagnoses include hematoma and connective tissue disorders.

The leg is usually painful, cyanosed (blue from lack of oxygen) and edematous (filled with fluid), which may result in venous gangrene.

Causes• Anyone can develop it but it becomes more

common with age. As well as age, risk factors include:

1. Previous venous thromboembolism.2. A family history of thrombosis3. Medical conditions such as cancer and

heart failure4. Inactivity (for example, after an operation) 5. Being overweight or obese.• In upper-extremity DVT, the most important

risk factor is having a central venous catheter, and thoracic outlet syndrome also increases risk.

Diagnosis

DVT diagnosis requires the use of imaging devices such as Ultrasonography and Venography.

Prevention and Treatment

• There are several things you can do to prevent DVT occurring, such as stopping smoking, losing weight if you are overweight and walking regularly to improve the circulation in your legs

• Walking and calf exercises reduce venous stasis because leg muscle contractions compress the veins and pump blood up towards the heart.

• Anticoagulation, which prevents further coagulation but does not act on existing clots, is the standard treatment for DVT.

• Two different types of anticoagulants are used to treat DVT:

• (a)Heparin and (b)Warfarin. • Compression stockings help prevent calf

pain and swelling and lower the risk of ulcers developing after having a DVT.

• As well as wearing compression stockings, you might be advised to raise your leg whenever you are resting. This helps to relieve the pressure in the veins of the calf and stops blood and fluid pooling in the calf itself.

• Aside from anticoagulation, the anti-platelet drug aspirin might be used in some orthopedic surgery patients.