Download MBBS Anatomy PPT 106 Vascular Anatomy Of Lower Limb Gk 1 Notes

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Lower Limb Venous Drainage

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Superficial veins : Great Saphenous Vein

and

Short Saphenous Vein

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Deep veins: Tibial, Peroneal,

Popliteal, Femoral

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veins

Perforators:

Blood flow

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deep veins in the sole

superficial veins in the dorsum

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But

In leg and thigh from superficial to

deep veins.

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Factors helping venous return

? Negative intra-thoracic pressure.
? Transmitted pulsations from adjacent arteries.
? Valves maintain uni-directional flow.

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? Valves in perforating veins prevent reflux into

low pressure superficial veins.

? Calf Pump--Peripheral Heart.

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? Vis-a ?tergo produced by contraction of heart.
? Suction action of diaphragm during inspiration.

Dorsal venous arch of Foot

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? It lies in the subcutaneous tissue over the

heads of metatarsals with convexity directed
distally.

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? It is formed by union of 4 dorsal metatarsal

veins.

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Each dorsal metatarsal
vein recieves blood in
the clefts from

? dorsal digital veins.

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? and proximal and distal

perforating veins
conveying blood from

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plantar surface of sole.

Great saphenous Vein

Begins from the medial

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side of dorsal venous

arch.

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Supplemented by

medial marginal vein

Ascends 2.5 cm

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anterior to medial

malleolus.

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Passes posterior to

medial border of

patella.

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Ascends along medial

thigh.

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Penetrates deep fascia

of femoral triangle:

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Pierces the Cribriform

fascia.

Saphenous opening.

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Drains into femoral

vein.

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superficial epigastric v.

superficial circumflex iliac v.

superficial ext. pudendal v.

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posteromedial vein

anterolateral vein

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GREAT SAPHENOUS VEIN

anterior leg vein

posterior arch vein

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dorsal venous arch

medial marginal vein

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Thoraco-epigastric vein
Deep external pudendal v.

Tributaries of Great Saphenous vein

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Tributaries of Great Saphenous vein

saphenous opening

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superficial epigastric

superficial circumflex iliac

superficial external

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pudendal

posteromedial vein

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anterolateral vein

adductor c. perforator

great saphenous vein

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anterior leg vein

posterior arch vein

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medial perforators

dorsal venous arch

medial marginal vein

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Short/ Lesser saphenous Vein:

Drains lateral side of
dorsal venous arch.

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Passes posterior to
lateral malleolus.

Accompanies sural nerve.

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Ascends along midline of
calf.

Empties into popliteal
vein in popliteal fossa.

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Short/ Lesser saphenous Vein:

Variable termination

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a) It may join GSV in upper

third of thigh either
directly or through
accesory saphenous

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vein.

b) May bifurcate : join GSV

and other in popliteal

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vein.

c) May end in GSV in leg

or deep vein of leg

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Deep veins

Present within the
deep fascia

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surrounded by
powerful muscles.

Blood flow in greater
pressure and volume.

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Accounts for 80 -90%
venous return.

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Deep veins

Accompany arteries

Below the knee-

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venae comitantes.

Above the knee-
single major vein

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Deep veins of lower limb

FEMORAL

Femoral vein

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POPLITEAL

PERONEAL

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POSTERIOR

TIBIAL

ANTERIOR

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TIBIAL

MEDIAL

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Popliteal vein

MALLEOLUS

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PERFORATORS

Communicate
superficial veins to
deep veins

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Have role in varicose
veins.

All veins in lower

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limb have valves

Fairly constant in position:

1 lateral ankle perforators

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3 Medial ankle perforators
a)Postero inferior to medial
malleolus
b)10 cm above med.malleolus
c)15 cm above med.malleolus

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3. Gastrocnemius perforators
of Boyd around knee
4. Mid thigh perforators of
Dodd
5. Hunter's perforator in thigh

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Valves in Great

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Saphenous Vein

?10-20 valves
?1 valve just before GSV

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pierces Cribriform fascia
? valve at Sapheno-femoral
junction
?In 80% of people, a valve
is present in external iliac

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vein which protects
Sapheno-femoral junction.

Varicose veins

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Dilated,tortuous and elongated veins
with reversal of blood flow mainly
due to valvular incompetence

Includes

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varicose veins in legs
Hemorrhoids
Varicocele
Oesophageal varices

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Risk factors

? Age
? Gender

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? Height
? left>right
? Heredity
? Pregnancy
? Obesity and overweight

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? Elevate intra abdominal pressure
? Deep vein thrombophlebitis
? Posture
? Incompetency of valves

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Saphena varix

A saphena varix is a dilatation

at the top of the Great

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saphenous vein due to valvular
incompetence.

The varix is:
? soft and compressible

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? disappears immediately on

lying down

? exhibits an expansile cough

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impulse


Trendelenburg test

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Used to assess the competence of

SFJ

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Patient lies flat.
Elevate the leg and gently empty the

veins

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Palpate the SFJ and ask the patient to

stand whilst maintaining pressure.

Rapid filling after thumb released SFJ is

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incompetent

Filling from below upwards without releasing

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thumb presence of distal incompetent

perforators
Patient in the supine position

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The lower limb raised above the level of heart

Tourniquet is then applied around the saphenofemoral junction to

compress the superficial veins (but not too tight as to occlude the

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deeper veins)

Then the patient asked to stand

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Normally, the superficial vein will fill from below within 30-35 seconds

If the superficial veins fill more rapidly with the tourniquet in place

there is valvular incompetence below the level of the tourniquet in the

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"deep veins or perforators.

If there has been no rapid filling even
after 20 seconds the tourniquet is

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released.

If rapid filling from above then it indicates
that the deep and perforating veins are
competent

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&

superficial veins are incompetent

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The test is reported in 2 parts

a) Standing up of the patient with tourniquet on

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based on rapid filling + or ?

deep veins/perforators

incompetent

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b) When Tourniquet is removed

based upon rapid filling + or - superficial vein

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incompetent

The test can be repeated with the tourniquet at different

levels to further pinpoint the level of valvular

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incompetence

Perthes Test

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Empty the vein as above, place a
tourniquet around the thigh, stand
the patient up.

Ask them to rapidly stand up and

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down on their toes

filling of the veins indicated deep
venous incompetence.

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This is a painful and rarely used
test.


VARICOSE ULCER

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Trendelenburg's
Operation

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VENOUS CUT DOWN

Cutaneous supply of skin immediately in
front of the medial malleolus is from
branches of saphenous nerve

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These branches are blocked with LA

A transverse incision is made through the
skin and subcutaneous tissue across

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the long axis of the vein just anterio-

superior to the medial malleolus.

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Femoral Vein

Catheterization

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Coronary artery bypass