Lesson # 34
Topography
and distribution of branches of femoral and popliteal arteries. Arteries of leg
and foot.
Anastomoses
between the arterial branches of lower extremity. Superficial and deep veins
and lymphatic nodes and vessels of lower extremity
Theme 1. Topography and distribution of branches of
femoral and popliteal arteries. Arteries of leg and foot. Anastomoses between
the arterial branches of lower extremity
Femoral artery is continuation of external iliac
artery, which passes under inguinal ligament through lacuna vasorum
laterally from femoral vein. Then femoral artery runs downward in iliopectineal
sulcus and anterior femoral sulcus. It enters into adductorial canal
and exits from canal in popliteal fossa where contines into popliteal
artery.
Femoral artery gives
off:
·
superficial epigastric artery
passes on anterior abdominal wall and supplies a inferior portion of external
oblique muscle aponeurosis and skin;
·
superficial circumflexа iliac artery passes
laterally and ramifies in muscles and skin near superior anterior iliac spina;
·
deep femoral artery
gives off medial circumflex femoral artery and lateral circumflexа
artery, three perforating arteries, that supply posterior group of
thigh muscles;
·
descending genu artery
begins from femoral artery in adductorial canal, passes through the tendinous
hiatus of this canal and passes down together with saphenus nerve to
knee-joint, where takes hand in formation of articulate knee net (rete
articulare genus).
The femoral artery.
Popliteal artery is continuation of femoral artery,
passes in advance of tibial nerve and popliteal vein and on level of inferior
margin of popliteal muscle divides into anterior tibial artery and posterior
tibial artery.
Popliteal artery gives off the following branches:
·
superior medial and lateral genu
arteries;
·
middle genu
artery;
·
inferior medial and lateral genu
arteries.
All these arteries participate in feeding of knee-joint and muscles
around it.
Circumpatellar anastomosis.
Posterior tibial artery continues from popliteal
artery, passes in cruropopliteal canal, under musculus soleus, behind
medial malleolus, passes in separate fibrous canal under flexors tendom
retinaculum on sole, where subdivides into medial plantar artery and lateral
plantar artery.
The popliteal, posterior tibial, and peroneal arteries.
Branches of posterior tibial artery:
·
fibular artery
passes in inferior musculоfibular channel, supplies peroneal muscles and behind
lateral malleolus divides into lateral maleolar branches and calcaneal
branches;
·
medial malleolar branches
take hand in formation of medial maleolar rete;
·
muscular branches
supply deep and superficial muscles of posterior group in shin;
·
fibular circumflexа branch
runs laterally from beginning of tibial artery and rounding a head of fibula
joins to articulate knee net;
·
lateral plantar artery
is a terminal branch of posterior tibial artery, lies in lateral plantar
sulcus, passes medially and, anastomosing with deep plantar branch (from dorsal
pedis artery), forms plantar arc. Lateral plantar artery gives off four plantar
metatarsal arteries, which continue into common plantar digital arteries. Last
subdivide into two proper plantar digital arteries, which supply skin of
both sides of each finger on sole;
·
medial plantar artery
is second terminal branches of posterior tibial artery (has a deep branch and
superficial branch), lies into medial plantar sulcus and supplies muscles of
medial plantar group, anastomosing with first dorsal metatarsal artery.
The plantar arteries. Superficial view.
·
Anterior tibial artery begins from popliteal
artery in popliteal fossa, runs at cruropopliteal canal and makes perforating
in superior portion of interossea membrane. Artery lies on anterior surface of
interossea membrane between muscles of anterior shin group and, passing under
retinaculum of extensor muscles, continues on foot under name of dorsal pedis
artery.
Anterior tibial artery gives off the following branches:
·
posterior recurrent tibial artery
takes hand in formation of articulate knee net;
·
anterior recurrent tibial artery
takes hand in formation of articulate knee net;
·
muscular branches
supply anterior shin muscles group;
·
anterior medial maleolar artery
takes hand in formation medial maleolar net;
Anterior tibial and dorsalis pedis arteries.
Superficial
and deep veins and lymphatic nodes and vessels of lower extremity
The Veins of the Lower Extremity
Just
as with the upper extremity, the veins of the lower extremity are divided into
deep and superficial, or subcutaneous, veins, which pass independently of the
arteries (Fig. 63).
The
deep
veins of
the foot and crus are binary and they accompany arteries of the same name. V.
poplitea, which is comprised of all the deep veins of the crus, constitutes a
single trunk lying in the popliteal fossa posteriorly and somewhat laterally of
the artery of the same name. V. femoralis is single; it originates laterally of
the femoral artery but, then, passes gradually to the posterior surface of the
artery, and as it rises higher, it passes onto the medial surface. From this
position the vein runs under the inguinal ligament into the lacuna vasorum. The
veins flowing into v. femoralis are all binary.
The
largest of the subcutaneous veins of the lower extremity are two trunks: v. saphena magna
and v. saphena parva. The long saphenous vein (vena saphena magna) originates on the dorsal
surface of the foot from rete venosum dorsale pedis and the arcus venosus
dorsalis pedis. Having received a few small branches from the side of the sole,
it passes upward along the medial side of the crus and femur. In the upper
one-third of the femur, it bends onto the anteromedial surface and, lying on
the broad fascia, runs toward the hiatus saphenus. At this point, it drains
into the femoral vein, passing over the lower horn of the crescent-shaped edge.
V. saphena magna
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quite often is binary with both its trunks draining
separately into the femoral vein. Among the other subcutaneous veins flowing
into the femoral vein, mention should be made of v. epigastrica superficialis,
v. circumflex a ilium superficialis, and vv. pudendae externae, which accompany
arteries of the same name. Some of them drain directly into the femoral vein;
others drain into v. saphena magna as it flows into the region of the hiatus
saphenus. The short saphenous vein (v. saphena parva) originates on the lateral side of the dorsal surface of
the foot, passes below and behind the lateral malleolus, and then rises along
the posterior surface of the crus. At first it runs along the lateral edge of
Achilles’ tendon and then proceeds upward along the middle of the posterior
segment of the crus corresponding to the groove between the heads of mm.
gastrocnemii. When it reaches the lower angle of the popliteal fossa, v.
saphena parva drains into the popliteal vein. V. saphena parva is joined by
branches to v. saphena magna.
DISTRIBUTION
OF THE VEINS
1. In the veins the
blood flows through the greater part of the body (the trunk and limbs) against
the force of gravity and, therefore, slower than in the arteries. The balance
in the heart is achieved because most of the venous bed is much wider than the
arterial bed. The greater width of the venous bed is the result of the
following anatomical adaptations: the larger calibre of the veins, their
greater number, the paired attendance of the arteries, the presence of veins
not accompanying arteries, the greater number of anastomoses, the denser venous
network, the formation of venous plexuses and sinuses, and the presence of a
portal system in the liver. Because of this, venous blood flows to the heart
along three large vessels (two venae cavae and the coronary sinus, in addition
to the small veins running to the heart), while from the heart blood flows only
along the aorta.
2. Deep veins
accompanying the arteries (venae commitantes) are distributed according to the
same laws as the arteries they accompany (see p. 93). Moreover, most of them
accompany the arteries in pairs. Where the venous outflow is most hampered,
i.e., in the extremities, the veins are mainly paired, since this arrangement
is the result of evolution in four-legged animals whose torsos are horizontal,
while both pairs of limbs are perpendicular to the ground.
3. Many superficial
veins lying under the skin accompany the nerves of the skin, although a
significant number form subcutaneous venous plexuses with no connection to
either the nerves or the arteries.
4. Venous plexuses are
mainly encountered in internal organs that change in volume in cavities with inflexible
walls. The plexuses facilitate the flow of venous blood when the organs
increase in size and are compressed by the walls. This explains the abundance
of venous plexuses around the organs of the small pelvis (urinary bladder,
uterus, rectum), in the vertebral canal, where the pressure of the
cerebrospinal fluid constantly fluctuates, and in similar places.
5. In the cranial cavity
where the slightest impediment to the venous outflow has an immediate effect on
brain functions, there are, besides the veins, venous sinuses with inflexible
walls formed by the dura mater. These spherical adaptations lie mainly where
the processes of the dura mater are
attached
to the bones of the skull (at the seams of tegmental bones and bone sulci of
analogous sinuses).
6. Among the special
adaptations are the diploic veins, venae diploicae.
HAEMATO-LYMPHATIC
RELATIONS
As
stated above, the thoracic duct drains into the left jugular vein or into the
angle of its confluence with .the left subclavian vein (angulus venosus sinister),
while the right lymphatic duct drains into the right subclavian vein. Lymph
flowing through these ducts, therefore, mixes with the blood flowing in the
veins so that a mixture of venous blood and lymph flows into the heart.
According
to the latest data, lymph flows into the venous paths not only where the
lymphatic ducts join the large veins running to the heart, but also in the
lymph nodes.
An exchange of fluid
between blood and lymph occurs in the nodes. Forty per cent of the lymph
(afferent) flowing into the node transfers into the venous paths of the lymph
nodes. In phlebohypertonia the reverse phenomenon is observed in the drained
organs: part of the blood plasma flows into the lymphatic sinuses of the nodes.
This reverse flow serves as one of the compensatory mechanisms in venous
hypertension.
THE DEVELOPMENT OF
LYMPHATIC VESSELS
The development of the
lymphatic system in the process of phylogenesis is closely related to the
development of blood circulation, which, in turn, is determined by the adaptation
of the respiratory organs to the environment (Fig. 76).
In aquatic fauna (fish which breathe with gills and have a dual-chamber
venous heart), iymph is propelled by the pulsations of the lymphatic heart, a
dilated lympthatic vessel that propels lymph into the venous bed. Fish have no
lymph nodes, and the lymphatic tissue is diffuse. In amphibians the number of
lymphatic hearts increases, and they are situated in pairs on the border
between the trunk and the extremities (anterior and posterior pairs). The
diffuse lymphatic tissue becomes concentrated in follicles located in the
mucous membranes.
When gills are
finally replaced by lungs in terrestrial animals and pulmonary circulation develops in addition to
systemic circulation, the movement of lymph is facilitated by the throbbing of
the heart. As a result the role of lymphatic hearts diminishes, and they
gradually disappear to be preserved only in a single (posterior) pair. At the
same time the overall number of lymphatic vessels increases.
In birds
lymphatic hearts are present only in the foetus, and the number of lymphatic
vessels increases. Valves appear inside the vessels, preventing the reverse
flow of lymph. Several lymph nodes make their appearance. With the appearance
of a muscular diaphragm in mammals and the further development of the heart
and blood vessels as well as the skeletal musculature, the movement of lymph is
eased by the suction action of the thoracic cage and the contraction of the
heart, blood vessels, and muscles. There is no longer any need for the
lymphatic hearts, and they disappear completely. At the same time, the number
of lymphatic vessels, in which many valves develop, increases. The lymph ducts
passing along the aorta merge into a large unpaired trunk, the ductus
thoracicus. The number of lymph nodes increases sharply, particularly in
primates.
Since human beings walk erect, the number of valves in the lymphatic
vessels of human extremities increases, particularly in the lower limbs. Humans
have the greatest number of lymph nodes of any species, which testifies to the
increased importance of the lymphatic system in limiting the spread of
pathological processes. A Soviet scientist Zhdanov maintains that the increase
of lymph nodes in man (even, in comparison with monkeys) is connected with
diet.
There are two
theories regarding the embryonic development of the lymphatic system. According to the centrifugal
development theory, as the first theory is called, the lymphatic system
develops out of the venous system. The second, theory contends that the system
originates separately out of the mesenchyme and only later joins the veins;
this theory is called the theory of centripetal development. Most authors
currently recognize the latter theory, according to which the lymphatic system
develops independently of the system of blood circulation and establishes
connections with the venous system secondarily. The lymphatic system originates
as detached germs, which grow, branch out, and form canals,
or lymph capillaries. Expanding and merging, these
capillaries, in their second month, form six lymph sacs: two by the jugular
veins, one retroperitoneal at the base of the mesentery, near the adrenals,
one neighbouring the preceding one (this is the cisterna chyli), and two by the
iliac veins.
The lymphatic
vessels of the head, neck, and upper extremity (these last from supplementary
sacs occurring by the subclavian veins) develop from jugular sacs. The retroperitoneal
S3C gives rise to vessels of the mesentery collecting lymph from the intestine.
The iliac sacs are the source for vessels of the lower limbs and pelvis.
Moreover, the jugular sacs grow in the direction of the thoracic cavity and
join in a single trunk, which meets the growing cisterna chyli. As a result a
thoracic duct uniting the systems of the iliac, retroperitoneal and jugular
sacs is formed. Thus, a single system of lymphatic vessels is created, which
makes contact with the venous system only near the jugular sacs at the
confluence of the jugular and subclavian veins on both sides of the body.
The initially symmetrical structure of the lymphatic system
is disturbed later, however, because the left duct (thoracic) develops to a
greater extent than the right. This greater development is explained by the
asymmetrical position of the heart and large veins which creates more
favourable conditions for the flow of lymph and blood through the left side in
the region of the left venous angle. On the right side, because of the
proximity to the venous half of the heart, there is a greater periodical
increase of pressure in the vena cava superior as the result of heart
contractions, which hampers the stream of lymph from freely joining the flow of
venous blood. This functional difference in the circulation through the right
and left main lymph trunks of the body also explains their unequal development.
A dual thoracic duct, common in lower vertebrates, is sometimes preserved as a
developmental variant in humans. Besides the lymphatic vessels and sacs, the
lymph nodes also develop, but somewhat later (in the third month).
THE
LYMPHATIC SYSTEM IN VARIOUS PARTS OF THE BODY
The lymphatic vessels
of the trunk, head, and limbs (i.e., of the soma) are divided into superficial
and deep vessels, separated by the deep fascia of the given region. Thus, the
lymphatic vessels of the skin, subcutaneous tissue, and part of the fascia, are
superficial, while all other vessels, i.e., the lymphatic vessels lying under
the fascia, are deep. The deep lymphatic system of the soma is built as
follows.
The deep lymphatic
vessels arising from the capillary lymph networks of joint capsules, muscles,
tendons, fasciae, nerves, and so on run, at first, as components of the
neurovascular bundles of these organs and then drain into the lymph collectors
of the given part of the body. In their turn the lymph collectors accompany
large arterial and venous trunks and drain into the regional lymph nodes.
THE LOWER EXTREMITY
The
lymph nodes of the lower extremity are located in the following places (Fig.
77).
1. Popliteal fossa—popliteal lymph glands (nodi lymphatici poplitet).
2. Inguinal region—inguinal lymph glands (nodi lymphatici
inguinales). They lie immediately under the inguinal ligament and are
divided into superficial and deep
inguinal lymph glands.
a)
superficial inguinal glands (nodi lymphatici
inguinales superficiales) are located on the wide fascia of the femur below its
perforation by v. saphena magna;
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b)deep inguinal glands (nodi
lymphatici.inguinales profundi) are locatea in the same region as the superficial glands
although under the wide fascir.
The
superficial lymphatic vessels drain into two groups of collect os running the
length of v. saphena magna to the medial group of the superficial inguinal
nodes and along v. saphena parva to the popliteal nodes of the posterolateral
group.
The
posterolateral group of collectors and the popliteal nodes, receive lymph from
the skin, subcutaneous tissue, and superficial fasciae of a small region of the
leg (the fourth and fifth toes, the lateral edge of the foot, the inferior
lateral surface of the crus, and the lateral part of the gastrocnemius region).
From all other parts of the leg, the lymph flows into the medial group of
collectors and then into the inguinal nodes without interruption in the
popliteal nodes.
This
explains the reaction of the inguinal nodes (tumescence and tenderness) in
purulent inflammation of the skin of the ungual phalanx of the big toe, for
example. The superficial lymphatic vessels of the upper one-third of the thigh
drain into the inguinal nodes, which also receive the superficial vessels of
the gluteal region, the anterior abdominal wall, and the external sexual
organs.
The
deep lymphatic vessels of the foot and crus, including the articular sac of the
knee joint, drain into the popliteal nodes. From there the lymph flows through
the deep collectors attendant to the femoral artery until it reaches the deep
inguinal nodes. These same collectors also receive lymph from the deep tissues
of the thigh. As a result, the large group of nodes located in the inguinal
region collects lymph from the entire lower limb, the anterior wall of the abdomen
(below the navel), the gluteal region, the perineum and external sexual organs,
and partly from the internal sexual organs (uterus).
The efferent vessels
of the inguinal nodes run the length of the external iliac artery and vein to
the iliac lymph nodes from where the lymph passes into the truncus lumbalis.
THE PELVIS
In
the pelvis the lymph nodes are mainly located along the blood vessels, as well
as on the surface of the internal organs. The following groups are found there:
1) external and common iliac lymph glands (nodi lymphatici iliaci externi and commune) along the external
artery and the common iliac artery; their efferent ducts are directed towards
nodi lymphatici lumbales; 2) internal iliac lymph glands (nodi lymphatici
iliaci interni) (9-12) on the lateral wall of the pelvic cavity; their
efferent ducts pass to the nodes located along the common iliac artery; 3)
sacral lymph glands (nodi lymphatici sac- rales), small nodes along a.
sacralis mediana; their efferent ducts run towards nodi lymphatici iliaci,
located near the promontorium. The efferent lymphatic vessels of the organs of
the minor pelvis drain into these nodes (see also the section on splanchnology)
(Fig. 77).
External iliac vein is continuation of femoral vein
and receives blood from all veins of lower limb. Inferior epigastric vein
and deep circumflexа ilei vein empties into external iliac vein under
inguinal ligament.
The
veins of lower limb subdivide into superficial and deep. Deep veins are double
and accompany same name artery (only a popliteal vein and femoral vein are
odd).
Follow
veins belong to superficial veins of lower limb:
1. Vena
saphena magna has numerous valves, starts in front of medial
malleolus, where receives influxes from plantar surface of foot, passes along saphenus
nerve on medial leg surface upward, than on medial surface on thigh to saphaenus
hiatus, where transfixes cribriform fascia and empties into femoral vein.
Vena saphena magna has the numerous subcutaneous tributaries from anteromedial
surface of leg, thigh and external genitals.
2. Vena
saphena parva has the numerous valves and collects blood from dorsal
venous arch of foot, passes behind lateral malleolus, lies into sulcus
between lateral and medial heads of gastrocnemius muscle and in popliteal
fossa empties into popliteal vein.
The
great saphenous vein and its tributaries at the fossa ovalis.
3.
Follow
vessels belong to deep veins of lower limb:
·
femoral vein;
·
deep femoral vein;
·
popliteal vein;
·
anterior tibial veins;
·
posterior tibial veins;
·
fibular veins.
The Superficial Veins of the Lower Extremity
The superficial veins of the lower extremity are the great
and small saphenous veins and their tributaries.
On the dorsum of the foot the dorsal digital veins
receive, in the clefts between the toes, the intercapitular veins from
the plantar cutaneous venous arch and join to form short common digital
veins which unite across the distal ends of the metatarsal bones in a dorsal
venous arch. Proximal to this arch is an irregular venous net-work which
receives tributaries from the deep veins and is joined at the sides of the foot
by a medial and a lateral marginal vein, formed mainly by the
union of branches from the superficial parts of the sole of the foot.
On the sole of the foot the superficial veins form a plantar
cutaneous venous arch which extends across the roots of the toes and opens
at the sides of the foot into the medial and lateral marginal veins. Proximal
to this arch is a plantar cutaneous venous net-work which is especially
dense in the fat beneath the heel; this net-work communicates with the
cutaneous venous arch and with the deep veins, but is chiefly drained into the
medial and lateral marginal veins.
The great saphenous vein (v. saphena magna;
internal or long saphenous vein) (581), the longest vein in the body, begins in the medial marginal vein
of the dorsum of the foot and ends in the femoral vein about
Tributaries.—At the ankle it
receives branches from the sole of the foot through the medial marginal vein;
in the leg it anastomoses freely with the small saphenous vein, communicates
with the anterior and posterior tibial veins and receives many cutaneous veins;
in the thigh it communicates with the femoral vein and receives numerous
tributaries; those from the medial and posterior parts of the thigh frequently
unite to form a large accessory saphenous vein which joins the main vein
at a variable level. Near the fossa ovalis (580) it is joined by the superficial epigastric, superficial iliac
circumflex, and superficial external pudendal veins. A vein, named the thoracoepigastric,
runs along the lateral aspect of the trunk between the superficial epigastric
vein below and the lateral thoracic vein above and establishes an important
communication between the femoral and axillary veins.
The valves in the great saphenous vein vary from ten to
twenty in number; they are more numerous in the leg than in the thigh.
The small saphenous vein (v. saphena parva;
external or short saphenous vein) (582)
begins behind the lateral
malleolus as a continuation of the lateral marginal vein; it first ascends
along the lateral margin of the tendocalcaneus, and then crosses it to reach
the middle of the back of the leg. Running directly upward, it perforates the
deep fascia in the lower part of the popliteal fossa, and ends in the popliteal
vein, between the heads of the Gastrocnemius. It communicates with the deep
veins on the dorsum of the foot, and receives numerous large tributaries from
the back of the leg. Before it pierces the deep fascia, it gives off a branch
which runs upward and forward to join the great saphenous vein. The small
saphenous vein possesses from nine to twelve valves, one of which is always
found near its termination in the popliteal vein. In the lower third of the leg
the small saphenous vein is in close relation with the sural nerve, in the
upper two-thirds with the medial sural cutaneous nerve.
The Deep Veins of the Lower Extremity
The deep veins of the lower extremity accompany the
arteries and their branches; they possess numerous valves.
The
great saphenous vein and its tributaries.
The
small saphenous vein.
The plantar digital veins (vv. digitales plantares)
arise from plexuses on the plantar surfaces of the digits, and, after
sending intercapitular veins to join the dorsal digital veins, unite to
form four metatarsal veins; these run backward in the metatarsal spaces,
communicate, by means of perforating veins, with the veins on the dorsum of the
foot, and unite to form the deep plantar venous arch which lies
alongside the plantar arterial arch. From the deep plantar venous arch the medial
and lateral plantar veins run backward close to the corresponding
arteries and, after communicating with the great and small saphenous veins,
unite behind the medial malleolus to form the posterior tibial veins.
The posterior tibial veins (vv. tibiales
posteriores) accompany the posterior tibial artery, and are joined by the peroneal
veins.
The anterior tibial veins (vv. tibiales anteriores)
are the upward continuation of the venæ comitantes of the dorsalis pedis artery.
They leave the front of the leg by passing between the tibia and fibula, over
the interosseous membrane, and unite with the posterior tibial, to form the popliteal
vein.
The Popliteal Vein (v. poplitea) (583) is formed by the junction of the anterior and posterior tibial veins at
the lower border of the Popliteus; it ascends through the popliteal fossa to
the aperture in the Adductor magnus, where it becomes the femoral vein. In the
lower part of its course it is placed medial to the artery; between the heads
of the Gastrocnemius it is superficial to that vessel; but above the
knee-joint, it is close to its lateral side. It receives tributaries
corresponding to the branches of the popliteal artery, and it also receives the
small saphenous vein. The valves in the popliteal vein are usually four in
number.
The femoral vein (v. femoralis) accompanies
the femoral artery through the upper two-thirds of the thigh. In the lower part
of its course it lies lateral to the artery; higher up, it is behind it; and at
the inguinal ligament, it lies on its medial side, and on the same plane. It
receives numerous muscular tributaries, and about
The Deep Femoral Vein (v. profunda femoris)
receives tributaries corresponding to the perforating branches of the profunda
artery, and through these establishes communications with the popliteal vein
below and the inferior gluteal vein above. It also receives the medial and
lateral femoral circumflex veins.
The popliteal vein.
The Veins of the Abdomen and Pelvis (585,
586,
587)
The external iliac vein (v. iliaca externa), the
upward continuation of the femoral vein, begins behind the inguinal ligament,
and, passing upward along the brim of the lesser pelvis, ends opposite the
sacroiliac articulation, by uniting with the hypogastric vein to form the
common iliac vein. On the right side, it lies at first medial to the artery:
but, as it passes upward, gradually inclines behind it. On the left side, it
lies altogether on the medial side of the artery. It frequently contains one,
sometimes two, valves.
Tributaries.—The external iliac vein receives the inferior
epigastric, deep iliac circumflex, and pubic veins.
The Inferior Epigastric Vein (v. epigastrica
inferior; deep epigastric vein) is formed by the union of the venæ
comitantes of the inferior epigastric artery, which communicate above with the
superior epigastric vein; it joins the external iliac about
The Deep Iliac Circumflex Vein (v. circumflexa
ilium profunda) is formed by the union of the venæ comitantes of the
deep iliac circumflex artery, and joins the external iliac vein about
The Pubic Vein communicates with the obturator vein
in the obturator foramen, and ascends on the back of the pubis to the external
iliac vein.
The hypogastric vein (v. hypogastrica; internal
iliac vein) begins near the upper part of the greater sciatic
foramen, passes upward behind and slightly medial to the hypogastric artery
and, at the brim of the pelvis, joins with the external iliac to form the common
iliac vein.
The
femoral vein and its tributaries.
Tributaries.—With the exception of the
fetal umbilical vein which passes upward and backward from the umbilicus to the
liver, and the iliolumbar vein which usually joins the common iliac vein, the
tributaries of the hypogastric vein correspond with the branches of the
hypogastric artery. It receives (a) the gluteal, internal pudendal,
and obturator veins, which have their origins outside the pelvis; (b)
the lateral sacral veins, which lie in front of the sacrum; and (c)
the middle hemorrhoidal, vesical, uterine, and vaginal veins, which
originate in venous plexuses connected with the pelvic viscera.
The Lymphatics of the
Lower Extremity
The superficial and deep vessels are distinguished in lower limb. The
superficial vessels are situated over superficial fascia and deep vessels
positioned closely to deep blood vessels. Popliteal nodes and inguinal
nodes are distinguished in lower limb. Last one subdivide into deep inguinal
nodes and superficial inguinal nodes. Superficial inguinal nodes dispose along
inguinal ligament and lie on superficial sheet of fascia lata femoris. Their
efferent vessels pass to external iliac nodes, which accompany same name
artery.
The superficial vessels of lower limb formed from capillary skin
networks and subcutaneous cellular tissue and form medial, lateral and
posterior vessel groups.
Medial group of superficial vessels formed in
skin of I, II and III fingers, medial part of foot and medial surface of shin.
These vessels run along vena saphena magna and empty into superficial inguinal
nodes.
Lateral group of superficial vessels of lower limb
formed laterally in area of fingers in dorsal foot surface and lateral surface
of shin. These vessels beneath knee join to medial group.
Posterior group of superficial vessels of lower limb
starts in skin of heel and plantar surface of lateral foot margin, passes along
the vena saphaena parva and runs into popliteal lymphatic nodes.
Deep vessels of lower limb drainage muscles, joints, synovial sheaths,
bones, nerves, accompany deep arteries and veins and empty into deep inguinal
nodes.
The Veins of the Lower Extremity
Just
as with the upper extremity, the veins of the lower extremity are divided into
deep and superficial, or subcutaneous, veins, which pass independently of the
arteries .
The
deep veins of the foot and crus are binary and they accompany
arteries of the same name. V. poplitea, which is comprised of all the deep
veins of the crus, constitutes a single trunk lying in the popliteal fossa
posteriorly and somewhat laterally of the artery of the same name. V. femoralis
is single; it originates laterally of the femoral artery but, then, passes
gradually to the posterior surface of the artery, and as it rises higher, it
passes onto the medial surface. From this position the vein runs under the
inguinal ligament into the lacuna vasorum. The veins flowing into v. femoralis
are all binary.
The
largest of the subcutaneous veins of the lower
extremity are two trunks: v. saphena magna and v. saphena parva. The long
saphenous vein (vena saphena magna) originates on the
dorsal surface of the foot from rete venosum dorsale pedis and the arcus
venosus dorsalis pedis. Having received a few small branches from the side of
the sole, it passes upward along the medial side of the crus and femur. In the
upper one-third of the femur, it bends onto the anteromedial surface and, lying
on the broad fascia, runs toward the hiatus saphenus. At this point, it drains
into the femoral vein, passing over the lower horn of the crescent-shaped edge.
V. saphena magna
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quite often is binary with both its trunks draining
separately into the femoral vein. Among the other subcutaneous veins flowing into
the femoral vein, mention should be made of v. epigastrica superficialis, v.
circumflex a ilium superficialis, and vv. pudendae externae, which accompany
arteries of the same name. Some of them drain directly into the femoral vein;
others drain into v. saphena magna as it flows into the region of the hiatus
saphenus. The short saphenous vein (v. saphena parva) originates on the
lateral side of the dorsal surface of the foot, passes below and behind the
lateral malleolus, and then rises along the posterior surface of the crus. At
first it runs along the lateral edge of Achilles’ tendon and then proceeds
upward along the middle of the posterior segment of the crus corresponding to
the groove between the heads of mm. gastrocnemii. When it reaches the lower
angle of the popliteal fossa, v. saphena parva drains into the popliteal vein.
V. saphena parva is joined by branches to v. saphena magna.
1. In the veins the
blood flows through the greater part of the body (the trunk and limbs) against
the force of gravity and, therefore, slower than in the arteries. The balance
in the heart is achieved because most of the venous bed is much wider than the
arterial bed. The greater width of the venous bed is the result of the
following anatomical adaptations: the larger calibre of the veins, their
greater number, the paired attendance of the arteries, the presence of veins
not accompanying arteries, the greater number of anastomoses, the denser venous
network, the formation of venous plexuses and sinuses, and the presence of a
portal system in the liver. Because of this, venous blood flows to the heart
along three large vessels (two venae cavae and the coronary sinus, in addition
to the small veins running to the heart), while from the heart blood flows only
along the aorta.
2. Deep veins
accompanying the arteries (venae commitantes) are distributed according to the
same laws as the arteries they accompany (see p. 93). Moreover, most of them
accompany the arteries in pairs. Where the venous outflow is most hampered,
i.e., in the extremities, the veins are mainly paired, since this arrangement
is the result of evolution in four-legged animals whose torsos are horizontal,
while both pairs of limbs are perpendicular to the ground.
3. Many superficial
veins lying under the skin accompany the nerves of the skin, although a significant
number form subcutaneous venous plexuses with no connection to either the
nerves or the arteries.
4. Venous plexuses are
mainly encountered in internal organs that change in volume in cavities with
inflexible walls. The plexuses facilitate the flow of venous blood when the
organs increase in size and are compressed by the walls. This explains the
abundance of venous plexuses around the organs of the small pelvis (urinary
bladder, uterus, rectum), in the vertebral canal, where the pressure of the cerebrospinal
fluid constantly fluctuates, and in similar places.
5. In the cranial cavity
where the slightest impediment to the venous outflow has an immediate effect on
brain functions, there are, besides the veins, venous sinuses with inflexible
walls formed by the dura mater. These spherical adaptations lie mainly where
the processes of the dura mater are
attached
to the bones of the skull (at the seams of tegmental bones and bone sulci of
analogous sinuses).
6. Among the special
adaptations are the diploic veins, venae diploicae.
