Arteries of Lower Limb
Medial and Lateral malleolar arteries
--- Content provided by FirstRanker.com ---
Lower Limb Venous Drainage
--- Content provided by FirstRanker.com ---
Superficial veins : Great Saphenous Veinand
Short Saphenous Vein
--- Content provided by FirstRanker.com ---
Deep veins: Tibial, Peroneal,
Popliteal, Femoral
--- Content provided by FirstRanker.com ---
veinsPerforators:
Blood flow
--- Content provided by FirstRanker.com ---
deep veins in the sole
superficial veins in the dorsum
--- Content provided by FirstRanker.com ---
ButIn leg and thigh from superficial to
deep veins.
--- Content provided by FirstRanker.com ---
Factors helping venous return? Negative intra-thoracic pressure.
? Transmitted pulsations from adjacent arteries.
? Valves maintain uni-directional flow.
--- Content provided by FirstRanker.com ---
? Valves in perforating veins prevent reflux intolow pressure superficial veins.
? Calf Pump--Peripheral Heart.
--- Content provided by FirstRanker.com ---
? Vis-a ?tergo produced by contraction of heart.? Suction action of diaphragm during inspiration.
Dorsal venous arch of Foot
--- Content provided by FirstRanker.com ---
? It lies in the subcutaneous tissue over theheads of metatarsals with convexity directed
distally.
--- Content provided by FirstRanker.com ---
? It is formed by union of 4 dorsal metatarsalveins.
--- Content provided by FirstRanker.com ---
Each dorsal metatarsalvein recieves blood in
the clefts from
? dorsal digital veins.
--- Content provided by FirstRanker.com ---
? and proximal and distal
perforating veins
conveying blood from
--- Content provided by FirstRanker.com ---
plantar surface of sole.Great saphenous Vein
Begins from the medial
--- Content provided by FirstRanker.com ---
side of dorsal venous
arch.
--- Content provided by FirstRanker.com ---
Supplemented bymedial marginal vein
Ascends 2.5 cm
--- Content provided by FirstRanker.com ---
anterior to medial
malleolus.
--- Content provided by FirstRanker.com ---
Passes posterior tomedial border of
patella.
--- Content provided by FirstRanker.com ---
Ascends along medial
thigh.
--- Content provided by FirstRanker.com ---
Penetrates deep fascia
of femoral triangle:
--- Content provided by FirstRanker.com ---
Pierces the Cribriformfascia.
Saphenous opening.
--- Content provided by FirstRanker.com ---
Drains into femoral
vein.
--- Content provided by FirstRanker.com ---
superficial epigastric v.superficial circumflex iliac v.
superficial ext. pudendal v.
--- Content provided by FirstRanker.com ---
posteromedial vein
anterolateral vein
--- Content provided by FirstRanker.com ---
GREAT SAPHENOUS VEINanterior leg vein
posterior arch vein
--- Content provided by FirstRanker.com ---
dorsal venous arch
medial marginal vein
--- Content provided by FirstRanker.com ---
Thoraco-epigastric veinDeep external pudendal v.
Tributaries of Great Saphenous vein
--- Content provided by FirstRanker.com ---
Tributaries of Great Saphenous vein
saphenous opening
--- Content provided by FirstRanker.com ---
superficial epigastricsuperficial circumflex iliac
superficial external
--- Content provided by FirstRanker.com ---
pudendal
posteromedial vein
--- Content provided by FirstRanker.com ---
anterolateral veinadductor c. perforator
great saphenous vein
--- Content provided by FirstRanker.com ---
anterior leg vein
posterior arch vein
--- Content provided by FirstRanker.com ---
medial perforatorsdorsal venous arch
medial marginal vein
--- Content provided by FirstRanker.com ---
Short/ Lesser saphenous Vein:
Drains lateral side of
dorsal venous arch.
--- Content provided by FirstRanker.com ---
Passes posterior to
lateral malleolus.
Accompanies sural nerve.
--- Content provided by FirstRanker.com ---
Ascends along midline ofcalf.
Empties into popliteal
vein in popliteal fossa.
--- Content provided by FirstRanker.com ---
Short/ Lesser saphenous Vein:
Variable termination
--- Content provided by FirstRanker.com ---
a) It may join GSV in upperthird of thigh either
directly or through
accesory saphenous
--- Content provided by FirstRanker.com ---
vein.b) May bifurcate : join GSV
and other in popliteal
--- Content provided by FirstRanker.com ---
vein.c) May end in GSV in leg
or deep vein of leg
--- Content provided by FirstRanker.com ---
Deep veins
Present within the
deep fascia
--- Content provided by FirstRanker.com ---
surrounded bypowerful muscles.
Blood flow in greater
pressure and volume.
--- Content provided by FirstRanker.com ---
Accounts for 80 -90%
venous return.
--- Content provided by FirstRanker.com ---
Deep veinsAccompany arteries
Below the knee-
--- Content provided by FirstRanker.com ---
venae comitantes.Above the knee-
single major vein
--- Content provided by FirstRanker.com ---
Deep veins of lower limbFEMORAL
Femoral vein
--- Content provided by FirstRanker.com ---
POPLITEAL
PERONEAL
--- Content provided by FirstRanker.com ---
POSTERIORTIBIAL
ANTERIOR
--- Content provided by FirstRanker.com ---
TIBIAL
MEDIAL
--- Content provided by FirstRanker.com ---
Popliteal veinMALLEOLUS
--- Content provided by FirstRanker.com ---
PERFORATORSCommunicate
superficial veins to
deep veins
--- Content provided by FirstRanker.com ---
Have role in varicose
veins.
All veins in lower
--- Content provided by FirstRanker.com ---
limb have valvesFairly constant in position:
1 lateral ankle perforators
--- Content provided by FirstRanker.com ---
3 Medial ankle perforatorsa)Postero inferior to medial
malleolus
b)10 cm above med.malleolus
c)15 cm above med.malleolus
--- Content provided by FirstRanker.com ---
3. Gastrocnemius perforatorsof Boyd around knee
4. Mid thigh perforators of
Dodd
5. Hunter's perforator in thigh
--- Content provided by FirstRanker.com ---
Valves in Great
--- Content provided by FirstRanker.com ---
Saphenous Vein
?10-20 valves
?1 valve just before GSV
--- Content provided by FirstRanker.com ---
pierces Cribriform fascia? valve at Sapheno-femoral
junction
?In 80% of people, a valve
is present in external iliac
--- Content provided by FirstRanker.com ---
vein which protectsSapheno-femoral junction.
Varicose veins
--- Content provided by FirstRanker.com ---
Dilated,tortuous and elongated veinswith reversal of blood flow mainly
due to valvular incompetence
Includes
--- Content provided by FirstRanker.com ---
varicose veins in legsHemorrhoids
Varicocele
Oesophageal varices
--- Content provided by FirstRanker.com ---
Risk factors
? Age
? Gender
--- Content provided by FirstRanker.com ---
? Height? left>right
? Heredity
? Pregnancy
? Obesity and overweight
--- Content provided by FirstRanker.com ---
? Elevate intra abdominal pressure? Deep vein thrombophlebitis
? Posture
? Incompetency of valves
--- Content provided by FirstRanker.com ---
Saphena varixA saphena varix is a dilatation
at the top of the Great
--- Content provided by FirstRanker.com ---
saphenous vein due to valvularincompetence.
The varix is:
? soft and compressible
--- Content provided by FirstRanker.com ---
? disappears immediately onlying down
? exhibits an expansile cough
--- Content provided by FirstRanker.com ---
impulse
Trendelenburg test
--- Content provided by FirstRanker.com ---
Used to assess the competence of
SFJ
--- Content provided by FirstRanker.com ---
Patient lies flat.Elevate the leg and gently empty the
veins
--- Content provided by FirstRanker.com ---
Palpate the SFJ and ask the patient tostand whilst maintaining pressure.
Rapid filling after thumb released SFJ is
--- Content provided by FirstRanker.com ---
incompetent
Filling from below upwards without releasing
--- Content provided by FirstRanker.com ---
thumb presence of distal incompetentperforators
Patient in the supine position
--- Content provided by FirstRanker.com ---
The lower limb raised above the level of heartTourniquet is then applied around the saphenofemoral junction to
compress the superficial veins (but not too tight as to occlude the
--- Content provided by FirstRanker.com ---
deeper veins)
Then the patient asked to stand
--- Content provided by FirstRanker.com ---
Normally, the superficial vein will fill from below within 30-35 secondsIf the superficial veins fill more rapidly with the tourniquet in place
there is valvular incompetence below the level of the tourniquet in the
--- Content provided by FirstRanker.com ---
"deep veins or perforators.
If there has been no rapid filling even
after 20 seconds the tourniquet is
--- Content provided by FirstRanker.com ---
released.If rapid filling from above then it indicates
that the deep and perforating veins are
competent
--- Content provided by FirstRanker.com ---
&
superficial veins are incompetent
--- Content provided by FirstRanker.com ---
The test is reported in 2 parts
a) Standing up of the patient with tourniquet on
--- Content provided by FirstRanker.com ---
based on rapid filling + or ?deep veins/perforators
incompetent
--- Content provided by FirstRanker.com ---
b) When Tourniquet is removed
based upon rapid filling + or - superficial vein
--- Content provided by FirstRanker.com ---
incompetentThe test can be repeated with the tourniquet at different
levels to further pinpoint the level of valvular
--- Content provided by FirstRanker.com ---
incompetence
Perthes Test
--- Content provided by FirstRanker.com ---
Empty the vein as above, place atourniquet around the thigh, stand
the patient up.
Ask them to rapidly stand up and
--- Content provided by FirstRanker.com ---
down on their toesfilling of the veins indicated deep
venous incompetence.
--- Content provided by FirstRanker.com ---
This is a painful and rarely usedtest.
VARICOSE ULCER
--- Content provided by FirstRanker.com ---
Trendelenburg's
Operation
--- Content provided by FirstRanker.com ---
VENOUS CUT DOWNCutaneous supply of skin immediately in
front of the medial malleolus is from
branches of saphenous nerve
--- Content provided by FirstRanker.com ---
These branches are blocked with LA
A transverse incision is made through the
skin and subcutaneous tissue across
--- Content provided by FirstRanker.com ---
the long axis of the vein just anterio-
superior to the medial malleolus.
--- Content provided by FirstRanker.com ---
Femoral Vein
Catheterization
--- Content provided by FirstRanker.com ---
Coronary artery bypass