Venous system
SYSTEM of
Superior vena cava is generated by reason of confluence of right and
left brachiocephalic veins behind joint of cartilage
of first right rib with sternum. Superior vena cava on level of third right
cartilage empties into right atrium. Azygos vein
empties into superior vena cava from right side.
Brachiocephalic veins
form by the confluence of subclavian vein, internal
jugular and sometimes External jugular vein. This place is called as venous
angle, where thoracic lymphatic duct empties (left side), and right
lymphatic duct (right side). Inferior thyroid veins from thyroid plexus,
inferior laryngeal vein and thymic
vein, pericardial veins from pericardium, bronchic
veins and esophageal veins from esophagus fall into brachiocephalic
veins.
Azygos vein
continues into thoracic cavity from right ascending lumbar vein. Azygos vein receives posterior intercostal
veins, esophageal veins, bronchic veins, pericardial veins and mediastinal veins, also hemizygos
vein.
Venous system of the
heart carries largest part of
deoxygenated blood into coronal sinus. Some veins empty in it:
-
greater
cardiac vein [vena cordis magna], which passes in anterior interventricular
sulcus and coronal sulcus;
-
lesser
cardiac vein [vena cordis parva], which passes in right part of coronal sulcus;
-
middle
cardiac vein [vena cordis media] passes in posterior interventricular
sulcus;
-
posterior
vein of left ventricle;
-
oblique vein of left atrium.
There are venae minimae (Tebezia) and anterior venae,
positioned in myocardium of right atrium.
Internal jugular vein is a largest vessel, which drainage blood from area
of head and neck. Internal jugular vein originates from sygmoid
sinus of dura mater encephali,
where it begins on level of jugular foramen by superior bulb and lies behind
internal carotid artery and vagus nerve. Inferior
jugular bulb is situated near the confluence with subclavian
vein.
Internal jugular has the
following extracranial influxes:
• pharyngeal veins;
• lingual vein;
• superior thyroid vein;
• facial vein, which
receives retromandibular vein
• retromandibular vein empties into facial vein,
or into internal jugular vein.
Follow vessels belong to
intracranial tributaries of internal jugular vein:
• venous sinuses of dura mater encephali and veins of
brain;
• diploic
veins from skull bones;
• meningeal
veins are from cranial dura mater;
• superior ophthalmic vein
and inferior ophtalmic vein is from sight
organ;
• labyrinthic
veins - from internal ear;
• emissary
veins from intracranial veins and sinuses of dura
mater and communicate with extracranial veins.
External jugular vein is generated by the confluence of occipital vein and
posterior auricular vein, which accompany same name arteries. External
jugular vein receives anterior jugular vein, which collect blood from
anterior neck area and, anastomosing each other, form
jugular venous arc.
Subclavian vein
continues from axillary vein, lies in
same name sulcus of first rib and collects blood from
thoracic veins and dorsal scapular vein.
The superior
vena cava (v. cava
superior) drains the blood from the upper half of the body. It measures
about
Relations.—In front are the anterior margins of the right
lung and pleura with the pericardium intervening below; these separate it from
the first and second intercostal spaces and from the
second and third right costal cartilages; behind it are the root of the right lung and
the right vagus nerve. On its right side are the phrenic
nerve and right pleura; on its left
side, the commencement of the
innominate artery and the ascending aorta, the latter
overlapping it. Just before it pierces the pericardium, it receives the azygos vein and several small veins from the pericardium
and other contents of the mediastinal cavity. The
portion contained within the pericardium is covered, in front and laterally, by
the serous layer of the membrane. The superior vena cava has no valves.
The azygos vein (v.
azygos; vena azygos major) begins opposite the first or second lumbar
vertebra, by a branch, the ascending
lumbar vein (page 678);
sometimes by a branch from the right renal vein, or from the inferior vena
cava. It enters the thorax through the aortic hiatus in the diaphragm, and
passes along the right side of the vertebral column to the fourth thoracic
vertebra, where it arches forward over the root of the right lung, and ends in
the superior vena cava, just before that vessel pierces the pericardium. In the
aortic hiatus, it lies with the thoracic duct on the right side of the aorta;
in the thorax it lies upon the intercostal arteries,
on the right side of the aorta and thoracic duct, and is partly covered by
pleura.
Tributaries.—It receives the right subcostal
and intercostal veins, the upper three or four of
these latter opening by a common stem, the highest superior intercostal
vein. It receives the hemiazygos veins, several
esophageal, mediastinal, and pericardial veins, and, near
its termination, the right bronchial vein. A few imperfect valves are found in
the azygos vein; but its tributaries are provided
with complete valves.
The intercostal veins on the left
side, below the upper three intercostal spaces, usually
form two trunks, named the hemiazygos and accessory hemiazygos
veins.
The Hemiazygos Vein (v. hemiazygos;
vena azygos minor inferior) begins in the left ascending lumbar or renal
vein. It enters the thorax, through the left crus of
the diaphragm, and, ascending on the left side of the vertebral column, as high
as the ninth thoracic vertebra, passes across the column, behind the aorta,
esophagus, and thoracic duct, to end in the azygos
vein. It receives the lower four or five intercostal
veins and the subcostal vein of the left side, and
some esophageal and mediastinal veins.
The Accessory
Hemiazygos Vein (v.
hemiazygos accessoria; vena
azygos minor superior) descends on the left side
of the vertebral column, and varies inversely in size with the highest left intercostal vein. It receives veins from the three or four intercostal spaces between the highest left intercostal vein and highest tributary of the hemiazygos; the left bronchial vein sometimes opens into
it. It either crosses the body of the eighth thoracic vertebra to join the azygos vein or ends in the hemiazygos.
When this vein is small, or altogether wanting, the left highest intercostal vein may extend as low as the fifth or sixth intercostal space.
In obstruction of the superior vena cava, the azygos and hemiazygos veins are
one of the principal means by which the venous circulation is carried on,
connecting as they do the superior and inferior venæ
cavæ, and communicating with the common iliac
veins by the ascending lumbar veins and with many of the tributaries of the
inferior vena cava.
The Bronchial
Veins (vv. bronchiales) return the blood from the larger bronchi,
and from the structures at the roots of the lungs; that of the right side opens
into the azygos vein, near its termination; that of
the left side, into the highest left intercostal or
the accessory hemiazygos vein. A considerable
quantity of the blood which is carried to the lungs through the bronchial
arteries is returned to the left side of the heart through the pulmonary veins.
The Veins of the Vertebral Column
The veins which drain the blood from the vertebral column,
the neighboring muscles, and the meninges of the
medulla spinalis form intricate plexuses extending along the entire length of the column;
these plexuses may be divided into two groups, external and internal, according
to their positions inside or outside the vertebral canal. The plexuses of the
two groups anastomose freely with each other and end
in the intervertebral veins.
The external
vertebral venous plexuses (plexus
venosi vertebrales externi; extraspinal veins)
best marked in the cervical region, consist of
anterior and posterior plexuses which anastomose
freely with each other. The anterior
external plexuses lie in
front of the bodies of the vertebræ,
communicate with the basivertebral and intervertebral veins, and receive tributaries from the
vertebral bodies. The posterior
external plexuses are placed
partly on the posterior surfaces of the vertebral arches and their processes,
and partly between the deep dorsal muscles. They are best developed in the
cervical region, and there anastomose with the
vertebral, occipital, and deep cervical veins.
The internal
vertebral venous plexuses (plexus
venosi vertebrales interni; intraspinal veins)
lie within the vertebral canal between the dura mater
and the vertebræ, and receive tributaries from
the bones and from the medulla spinalis. They form a
closer net-work than the external plexuses, and, running mainly in a vertical
direction, form four longitudinal veins, two in front and two behind; they
therefore may be divided into anterior and posterior groups. Theanterior internal plexuses consist of large veins which lie on
the posterior surfaces of the vertebral bodies and intervertebral
fibrocartilages on either side of the posterior
longitudinal ligament; under cover of this ligament they are connected by
transverse branches into which the basivertebral
veins open. The posterior
internal plexuses are placed,
one on either side of the middle line in front of the vertebral arches and ligamenta flava, and anastomose by veins passing through those ligaments with
the posterior external plexuses. The anterior and posterior plexuses
communicate freely with one another by a series of venous rings (retia
venosa vertebrarum),
one opposite each vertebra. Around the foramen magnum they form an intricate
net-work which opens into the vertebral veins and is connected above with the
occipital sinus, the basilar plexus, the condyloid
emissary vein, and the rete canalis
hypoglossi.
The basivertebral veins (vv. basivertebrales)
emerge from the foramina on the posterior surfaces of the vertebral bodies. They
are contained in large, tortuous channels
in the substance of the bones, similar in every respect to those found in the diploë of the cranial bones. They communicate through
small openings on the front and sides of the bodies of the vertebræ
with the anterior external vertebral plexuses, and converge behind to the
principal canal, which is sometimes double toward its posterior part, and open
by valved orifices into the transverse branches which
unite the anterior internal vertebral plexuses. They become greatly enlarged in
advanced age.
The intervertebral veins (vv. intervertebrales)
accompany the spinal nerves through the intervertebral
foramina; they receive the veins from the medulla spinalis,
drain the internal and external vertebral plexuses and end in the vertebral, intercostal, lumbar, and lateral sacral veins, their
orifices being provided with valves.
The veins
of the medulla spinalis (vv. spinales;
veins of the spinal cord) are situated in the pia
mater and form a minute, tortuous, venous plexus. They emerge chiefly from the
median fissures of the medulla spinalis and are
largest in the lumbar region. In this plexus there are (1) two median
longitudinal veins, one in front of the anterior fissure, and the other behind
the posterior sulcus of the cord, and (2) four lateral
longitudinal veins which run behind the nerve roots. They end in the intervertebral veins. Near the base of the skull they
unite, and form two or three small trunks, which communicate with the vertebral
veins, and then end in the inferior cerebellar veins,
or in the inferior petrosal sinuses.
Brachiocephalic veins are two large trunks, placed one on either side of the root of the
neck, and formed by the union of the internal jugular and subclavian
veins of the corresponding side; they are devoid of valves. The right brachiocephalic vein is a short vessel, about
Veins of upper limb are subdivided into superficial and deep. They are
communicated by numerous anastomoses and have valves.
The axillary vein (v. axillaris) begins at the lower border of the Teres major, as the continuation of the basilic
vein, increases in size as it ascends, and ends at the outer border of the
first rib as the subclavian vein. Near the lower
border of the Subscapularis it receives the brachial
veins and, close to its termination, the cephalic vein; its other tributaries
correspond with the branches of the axillary artery. It
lies on the medial side of the artery, which it partly overlaps; between the
two vessels are the medial cord of the brachial plexus, the median, the ulnar, and
the medial anterior thoracic nerves. It is provided with a pair of valves
opposite the lower border of the Subscapularis;
valves are also found at the ends of the cephalic and subscapular
veins.
The subclavian vein (v. subclavia),
the continuation of the axillary, extends from the
outer border of the first rib to the sternal end of
the clavicle, where it unites with the internal jugular to form the innominate vein. It is in relation, in front, with the clavicle and Subclavius; behind andabove, with the subclavian
artery, from which it is separated medially by the Scalenus
anterior and the phrenic nerve. Below, it rests in a depression on the first
rib and upon the pleura. It is usually provided with a pair of valves, which
are situated about
The subclavian vein occasionally
rises in the neck to a level with the third part of the subclavian
artery, and occasionally passes with this vessel behind the Scalenus
anterior.
The veins of the upper extremity are divided
into two sets, superficial and deep; the two sets
anastomose frequently with each other. The
superficial veins are placed immediately beneath the integument between the two
layers of superficial fascia. The deep veins accompany the arteries, and
constitute the venæ comitantes
of those vessels. Both sets are provided with valves, which are more numerous
in the deep than in the superficial veins.
The Superficial Veins of the Upper
Extremity
The superficial
veins of the upper extremity
are the digital, metacarpal,
cephalic, basilic, median.
The dorsal digital
veins pass along the sides of
the fingers and are joined to one another by oblique communicating branches. Those
from the adjacent sides of the fingers unite to form three dorsal metacarpal veins , which
end in a dorsal venous net-work opposite the middle of the metacarpus. The
radial part of the net-work is joined by the dorsal digital vein from the
radial side of the index finger and by the dorsal digital veins of the thumb,
and is prolonged upward as the cephalic vein. The ulnar
part of the net-work receivesthe dorsal digital vein
of the ulnar side of the little finger and is
continued upward as the basilic vein. A communicating
branch frequently connects the dorsal venous network with the cephalic vein
about the middle of the forearm.
The volar digital veins on each finger are connected to the
dorsal digital veins by obliqueintercapitular
veins. They drain into a
venous plexus which is situated over the thenar and hypothenar eminences and across the front of the wrist.
The cephalic
vein begins in the radial part of the dorsal
venous net-work and winds upward around the radial border of the forearm,
receiving tributaries from both surfaces. Below the front of the elbow it gives
off the vena mediana cubiti (median basilic
vein), which receives a communicating branch from the deep veins of the
forearm and passes across to join the basilic vein. The
cephalic vein then ascends in front of the elbow in the groove between the Brachioradialis and the Biceps brachii.
It crosses superficial to the musculocutaneous nerve
and ascends in the groove along the lateral border of the Biceps brachii. In the upper third of the arm it passes between
the Pectoralis major and Deltoideus,
where it is accompanied by the
deltoid branch of the thoracoacromial artery. It
pierces the coracoclavicular fascia and, crossing the
axillary artery, ends in the axillary
vein just below the clavicle. Sometimes it communicates with the external
jugular vein by a branch which ascends in front of the clavicle.
The accessory
cephalic vein (v. cephalica accessoria) arises either from a small tributory plexus on the back of the forearm or from the ulnar side of the dorsal venous net-work; it joins the
cephalic below the elbow. In some cases the accessory cephalic springs from the
cephalic above the wrist and joins it again higher up. A large oblique branch
frequently connects the basilic and cephalic veins on
the back of the forearm.
The basilic vein (v. basilica) begins in the ulnar
part of the dorsal venous network. It runs up the posterior surface of the ulnar side of the forearm and inclines forward to the
anterior surface below the elbow, where it is joined by the vena mediana cubiti. It ascends
obliquely in the groove between the Biceps brachii
and Pronator teres and
crosses the brachial artery, from which it is separated by the lacertus fibrosus; filaments of
the medial antibrachial cutaneous
nerve pass both in front of and behind this portion of the vein. It then runs
upward along the medial border of the Biceps brachii,
perforates the deep fascia a little below the middle of the arm, and, ascending
on the medial side of the brachial artery to the lower border of the Teres major, is continued onward as the axillary
vein.
The median antibrachial vein (v.
mediana antibrachii)
drains the venous plexus on the volar surface of the
hand. It ascends on the ulnar side of the front of
the forearm and ends in the basilic vein or in the
vena mediana cubiti; in a
small proportion of cases it divides into two branches, one of which joins the basilic, the other the cephalic, below the elbow.
The Deep Veins of the Upper Extremity
The deep
veins follow the course of
the arteries, forming their venæ comitantes. They are generally arranged in pairs, and are
situated one on either side of the corresponding artery, and connected at
intervals by short transverse branches.
Deep Veins of the Hand.—The superficial and deep volar arterial arches are each accompanied by a pair of venæ comitantes which
constitute respectively the superficial anddeep
volar venous arches, and receive the veins corresponding to
the branches of the arterial arches; thus the common
volar digital veins, formed by the union of the proper volar
digital veins, open into the
superficial, and the volar metacarpal veins into the deep volar
venous arches. The dorsal
metacarpal veins receive
perforating branches from the volar metacarpal veins
and end in the radial veins and in the superficial veins on the dorsum of the
wrist.
The deep
veins of the forearm are the venæ comitantes of the
radial and ulnar veins and constitute respectively
the upward continuations of the deep and superficial volar
venous arches; they unite in front of the elbow to form the brachial veins. The
radial veins are smaller than the ulnar and receive
the dorsal metacarpal veins. The ulnar veins receive
tributaries from the deep volar venous arches and
communicate with the superficial veins at the wrist; near the elbow they
receive the volar and dorsal interosseous
veins and send a large communicating branch (profunda
vein) to the vena mediana cubiti.
The brachial
veins (vv. brachiales) are placed one on either side of the
brachial artery, receiving tributaries corresponding with the branches given
off from that vessel; near the lower margin of the Subscapularis,
they join the axillary vein; the medial one
frequently joins the basilic vein.
These deep veins have numerous anastomoses,
not only with each other, but also with the superficial veins.
Superficial veins are developed richer than deep one.
Cephalic vein starts from radial part of dorsal venous hand net.
From dorsal hand surface it passes on anterior surface of radial margin across
forearm, lies into lateral biceps brachii sulcus, then into sulcus
between deltoid and major pectoral muscles and empties under clavicle into axillaró vein.
Basilica vein collects blood from ulnar
part of dorsal venous hand net, lies on ulnar
side of anterior forearm surface, passes on medial biceps brachii sulcus and empties
into one of brachial veins.
Intermediate cubiti vein
passes obliquely in area of cubital fossa from cephalic to basilica veins.
The Deep veins of upper
limb are double, they start
from superficial palmar venous arch and deep palmar venous arch then accompanies same name arteries and.
Axillar vein
is odd, it accompanies same name artery and continues into subclavian
vein.
SYSTEM of INFERIOR VENA CAVA
Inferior vena cava starts on level IV-V lumbar vertebrae by the
confluence of left common iliac vein and right common iliac vein, to the right
and beneath from bifurcation of aorta. It passes through special foramen in centrum tendineum of diaphragm
into mediastinum and empties into right atrium.
There are parietal and
visceral influxes of inferior vena cava.
Parietal tributaries of inferior vena cava:
·
lumbar
veins are 3-4 pairs, which
collect blood from areas according with ramification of lumbar arteries, they anastomose by right and left ascending lumbar
veins;
·
inferior phrenic veins collect blood from areas according with
ramification same name arteries.
Follow veins are the visceral
tributaries of inferior vena cava:
·
in
male - right testicular vein starts from posterior testicle margin.
Testicular vein forms pampiniform plexus
which enters to composition of spermatic cord. Left testicular vein
(also left ovaricà vein in famile)
empties by right angle into left renal vein;
·
in famile - right ovaric vein
begins from ovary hilus;
·
renal
veins, pair, pass from kidney
hilus and, anastomosing
with lumbar veins, emptiy into inferior vena cava
between lumbar vertebrae first and second;
·
right suprarenal vein, exits from hilus of adrenal gland. Left suprarenal vein falls
into left renal vein;
·
hepatic veins
(3-4) veins fall into inferior vena cava in area of same name sulcus in liver.
Vena portae
hepatis
is situated in thickness of hepatoduodenal
ligament between ductus choledochus
and proper hepatic artery (formula of their position DVA – from right to left).
It originates behind head of pancreas by the confluence of superior,
inferior mesenteric veinc and splenic vein. It collects venous blood from odd
organs of abdominal cavity, except liver. Vena portae
receives cystic vein, right and left gastric veins and prepyloric vein closely to liver hilus.
Paraumbilical veins fall into portal
vein in liver hilus.
There are
cava-caval and porto-caval anastomoses between systems of portal vein, superior and
inferior vanea cavae (see
table on the next page).
System |
Veins |
Veins |
Position of anastomose |
V. cava superior And v. cava inferior |
v. epigastrica superior
(tributary of the internal thoracic vein) and v. Thoracoepigastrica
(tributary of the subclavian vein) |
v. epigastrica inferior
(tributary of the external iliac vein) and v. Epigastrica
superficialis (tributary of the femoral vein) |
In anterior abdominal wall round the navel |
V. cava superior And v. Cava inferior |
vv. azygos and hemiazygos |
vv. lumbales |
On posterior abdominal wall |
V. cava superior And v. Cava inferior |
Rr.
spinales (tributary of the vv. Intercostales
posteriores) |
Rr.
spinales (tributary of the vv. Lumbales)
|
Form internal and external vertebral plexus |
V. cava superior and v. Portae |
v. epigastrica superior (tributary
of the internal thoracic vein) |
Vv. paraumbilicales |
In anterior abdominal wall round the navel |
V. cava superior and v. Portae |
Vv. esophageales
(tributary of the azygos vein) |
v. gastrica sinistra |
Near gastric cardia |
V. cava inferior and v. Portae |
v. epigastrica inferior
(tributary of the external iliac vein) |
Vv. paraumbilicales |
In anterior abdominal wall |
V. cava inferior and v. Portae |
V. rectalis media
(tributary of the internal iliac vein) |
V. rectalis superior
(tributary of the inferior mesenteric vein) |
Plexus venosus rectalis |
V. cava inferior and v. Portae |
Vv. lumbales |
Vv. mesenterica superior
and inferior |
In thickness of ascending and descending colon |
VEINS of PELVIS and
LOWER LIMB
The common iliac
veins arose on level of sacroiliac joint by the confluence of internal
iliac vein and external iliac vein.
Internal iliac vein has parietal and visceral influxes
according to ramification of same name arteries.
Visceral tributaries of internal iliac vein form from such venous
plexuses:
·
sacral
venous plexus;
·
vesical venous plexus;
·
rectal
venous plexus.
External iliac vein is continuation of femoral vein and receives
blood from all veins of lower limb. Inferior epigastric
vein and deep circumflexà 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.
Follow vessels belong to
deep veins of lower limb:
·
femoral
vein;
·
deep
femoral vein;
·
popliteal vein;
·
anterior
tibial veins;
·
posterior
tibial veins;
·
fibular veins.
Circulatory system of
the foetus has a row of peculiarities that differ from adult one:
-
arterial
blood reaches the foetus through umbilical vein from placenta;
-
exclusive
of umbilical vein, a blood in vessels is mixed;
-
venous
(Àranti) duct functions between umbilical and inferior vena cava by
veins;
-
blood
from inferior vena cava gets from right atrium through the ovale
foramen into left atrium;
-
pulmonary
circulation does not function;
-
arterial
(Botalova) duct functions between aortic arch and pulmonary trunk,
through the which blood from pulmonary blood circle passes in systemic
circulation;
-
more
oxygenated blood supplies head, neck, upper limbs and superior part of torso.
Inferior part of trunk and lower limbs supplied by mixed blood, which is
insufficiently saturated by oxygen, that's why these body portions of foetus
fall behind in development in compare of head and upper part of torso.
After birth breath
starts and pulmonary circulation begins to function. Umbilical vessels overgrow
in 6-7 days, Botali duct - in 9-10 days and oval foramen in interatrial wall – in 30 days after birth.