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

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Arteries of Lower Limb


Medial and Lateral malleolar arteries



Lower Limb Venous Drainage

Superficial veins : Great Saphenous Vein

and

Short Saphenous Vein

Deep veins: Tibial, Peroneal,

Popliteal, Femoral

veins

Perforators:

Blood flow

deep veins in the sole

superficial veins in the dorsum

But

In leg and thigh from superficial to

deep veins.
Factors helping venous return

? Negative intra-thoracic pressure.
? Transmitted pulsations from adjacent arteries.
? Valves maintain uni-directional flow.
? Valves in perforating veins prevent reflux into

low pressure superficial veins.

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

Dorsal venous arch of Foot

? It lies in the subcutaneous tissue over the

heads of metatarsals with convexity directed
distally.

? It is formed by union of 4 dorsal metatarsal

veins.


Each dorsal metatarsal
vein recieves blood in
the clefts from

? dorsal digital veins.

? and proximal and distal

perforating veins
conveying blood from
plantar surface of sole.

Great saphenous Vein

Begins from the medial

side of dorsal venous

arch.

Supplemented by

medial marginal vein

Ascends 2.5 cm

anterior to medial

malleolus.

Passes posterior to

medial border of

patella.


Ascends along medial

thigh.

Penetrates deep fascia

of femoral triangle:

Pierces the Cribriform

fascia.

Saphenous opening.

Drains into femoral

vein.

superficial epigastric v.

superficial circumflex iliac v.

superficial ext. pudendal v.

posteromedial vein

anterolateral vein

GREAT SAPHENOUS VEIN

anterior leg vein

posterior arch vein

dorsal venous arch

medial marginal vein

Thoraco-epigastric vein
Deep external pudendal v.

Tributaries of Great Saphenous vein


Tributaries of Great Saphenous vein

saphenous opening

superficial epigastric

superficial circumflex iliac

superficial external

pudendal

posteromedial vein

anterolateral vein

adductor c. perforator

great saphenous vein

anterior leg vein

posterior arch vein

medial perforators

dorsal venous arch

medial marginal vein

Short/ Lesser saphenous Vein:

Drains lateral side of
dorsal venous arch.

Passes posterior to
lateral malleolus.

Accompanies sural nerve.
Ascends along midline of
calf.

Empties into popliteal
vein in popliteal fossa.


Short/ Lesser saphenous Vein:

Variable termination
a) It may join GSV in upper

third of thigh either
directly or through
accesory saphenous
vein.

b) May bifurcate : join GSV

and other in popliteal
vein.

c) May end in GSV in leg

or deep vein of leg

Deep veins

Present within the
deep fascia
surrounded by
powerful muscles.

Blood flow in greater
pressure and volume.

Accounts for 80 -90%
venous return.


Deep veins

Accompany arteries

Below the knee-
venae comitantes.

Above the knee-
single major vein

Deep veins of lower limb

FEMORAL

Femoral vein

POPLITEAL

PERONEAL

POSTERIOR

TIBIAL

ANTERIOR

TIBIAL

MEDIAL

Popliteal vein

MALLEOLUS


PERFORATORS

Communicate
superficial veins to
deep veins

Have role in varicose
veins.

All veins in lower
limb have valves

Fairly constant in position:

1 lateral ankle perforators
3 Medial ankle perforators
a)Postero inferior to medial
malleolus
b)10 cm above med.malleolus
c)15 cm above med.malleolus
3. Gastrocnemius perforators
of Boyd around knee
4. Mid thigh perforators of
Dodd
5. Hunter's perforator in thigh




Valves in Great

Saphenous Vein

?10-20 valves
?1 valve just before GSV
pierces Cribriform fascia
? valve at Sapheno-femoral
junction
?In 80% of people, a valve
is present in external iliac
vein which protects
Sapheno-femoral junction.

Varicose veins

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

Includes
varicose veins in legs
Hemorrhoids
Varicocele
Oesophageal varices


Risk factors

? Age
? Gender
? Height
? left>right
? Heredity
? Pregnancy
? Obesity and overweight
? Elevate intra abdominal pressure
? Deep vein thrombophlebitis
? Posture
? Incompetency of valves

Saphena varix

A saphena varix is a dilatation

at the top of the Great
saphenous vein due to valvular
incompetence.

The varix is:
? soft and compressible
? disappears immediately on

lying down

? exhibits an expansile cough

impulse


Trendelenburg test

Used to assess the competence of

SFJ

Patient lies flat.
Elevate the leg and gently empty the

veins

Palpate the SFJ and ask the patient to

stand whilst maintaining pressure.

Rapid filling after thumb released SFJ is

incompetent

Filling from below upwards without releasing

thumb presence of distal incompetent

perforators
Patient in the supine position

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

deeper veins)

Then the patient asked to stand

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

"deep veins or perforators.

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

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

&

superficial veins are incompetent


The test is reported in 2 parts

a) Standing up of the patient with tourniquet on

based on rapid filling + or ?

deep veins/perforators

incompetent

b) When Tourniquet is removed

based upon rapid filling + or - superficial vein

incompetent

The test can be repeated with the tourniquet at different

levels to further pinpoint the level of valvular

incompetence

Perthes Test

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

Ask them to rapidly stand up and
down on their toes

filling of the veins indicated deep
venous incompetence.

This is a painful and rarely used
test.


VARICOSE ULCER


Trendelenburg's
Operation

VENOUS CUT DOWN

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

These branches are blocked with LA

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

the long axis of the vein just anterio-

superior to the medial malleolus.


Femoral Vein

Catheterization

Coronary artery bypass

This post was last modified on 05 April 2022