veins and lymphatics of the lower limbs and

8/9/2019 Veins and Lymphatics of the Lower Limbs And

1/31


2/31

VEINS OF THE LOWER LIMBConsist of:

The deep veins

The superficial veins


3/31

Veins of Upper Limby Superficial Veins

y Placed between the integument between the two layers ofthe superficial fascia

y Deep Veins

y Accompany the arteries

y Valvesy Both set of veins are provided with valves

y More numerous in deep than in superficial set

y Also more numerous in the lower limb than upper limb


4/31

Superficial veins of the lower

extremityy Great Saphenous Vein

y Small Saphenous vein

y Their tributaries


5/31

Superficial Veins of the Lower limby Great Saphenous Veiny The longest vein in the bodyy Begins in the medial marginal vein in the dorsum of the

footy Ends in the femoral vein about 3 cm. below the inguinal

ligamenty Ascends in the front of the tibial malleolusy And along the medial side of the leg in relation with the

saphenous nervey Runs upward behind the medial condyles of tibia and the

femur and along the medial side of the thighy Passing through the fossa ovalis ends in the femoral vein


6/31

Great Saphenous Veiny The great saphenous vein (also called the large

saphenous vein) goes from the foot all the way up to

the saphenous opening, an oval aperture in the broadfascia of the thigh, a fibrous membrane through whichthe vein passes.


7/31

Superficial Veins of the Lower Limby Tributaries ofGreat Saphenous Vein

y Accesory Saphenous Veiny Thoracoepigastric Vein


8/31

Great Saphenous Vein


9/31

Clinical Significancey Great Saphenous Vein

y The saphenous vein is usually the conduit of choice to

bypass arterial blockages, to perform arterial bypassgrafts and cardiac procedures


10/31

TECHNIQUE FOR

SAPHENOUS VEIN

HARVESTING

The VASOVIEW, from Origin,allows saphenous veinharvesting using only 2 to 4small incisions with obviousbenefits such as less postoperative pain, less scaring,

infection rate and less hospitalstay.A 2 cm incision is made at thegroin, and the great saphenousvein is identified. The tissuesurrounding the vein isdissected completely until theadventitia is exposed.


11/31

Small Saphenous Veiny Begins behind the lateral malleolus as the

continuation of the lateral margin vein

yThe small saphenous vein runs behind the outermalleolus (the protuberance on the outside of theankle joint), comes up the back of the leg and joins thepopliteal vein in the space behind the knee (the

popliteal space).


12/31

Clinical Significance of Small

Saphenous Veinsy Varicose Veins

y Varicose veins are enlarged veins that are swollen and raisedabove the surface of the skin. They can be dark purple or blue,

and look twisted and bulging. Varicose veins are commonlyfound on the backs of the calves or on the inside of the leg. Theydevelop when valves in the veins that allow blood to flow towardthe heart stop working properly. As a result, blood pools in the

veins and causes them to get larger.

y

Varicose veins affect 1 out of 2 people over age 50. They are morecommon in women than men.

y Exercising, losing weight, elevating your legs when resting andnot crossing them when sitting can help keep varicose veins fromgetting worse.


13/31

Varicose Veins in the Lower Limbs


14/31

Small Saphenous Vein


15/31

Deep Veins of the Lower extremityy TheDeep Veins of the Lower Extremity

y Accompany the arteries and their branches

y They possess numerous valves


16/31

Clinical Significance ofDeep VeinsyWhat IsDeep VeinThrombosis?

y Deep vein thrombosis (throm-BO-sis), orDVT, is a

blood clot that forms in a vein deep in the bodyy Blood clots occur when blood thickens and clumps

together.

y Most deep vein blood clots occur in the lower leg or

thighy Also can occur in other parts of the body


17/31

Clinical Significancey Deep Vein Thrombosisy Ablood clot in a deep vein can break off and travel through

the bloodstream. The loose clot is called an embolus.

When the clot travels to the lungs and blocks blood f low,the condition is called pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE.

y PE is a very serious condition. It can damage the lungs andother organs in the body and cause death.

y B

lood clots in the thigh are more likely to break off andcause PE than blood clots in the lower leg or other parts ofthe body.

y Blood clots also can form in veins closer to the skin'ssurface. However, these clots won't break off and cause PE.


18/31

Lymphatics of the Lower Limby Consists of the:

y Anterior Tibial Gland

y PoplitealGlandy Inguinal Gland


19/31

Deep Vein Thrombosis


20/31

Lymphatics of the Lower Limb

y The anterior tibial gland (lymphoglandula tibialis

anterior)y Is small and inconstant

y Lies on the interosseous membrane in relation to theupper part of the anterior tibial vessels

y Constitutes a substation in the course of the anteriortibial lymphatic trunks.


21/31

Lymphatics of the lower limby The popliteal glands (lymphoglandul poplite)

y Small in size and some six or seven in number

y Are imbedded in the fat contained in the poplitealfossa

y One lies immediately beneath the popliteal fascia,near the terminal part of the small saphenous vein,

and drains the region from which this vein derives itstributaries


22/31

Lymphatics of the Lower Limby The inguinal glands (lymphoglandul inguinales)

y From twelve to twenty in number

y

Are situated at the upper part of the femoral triangle.y May be divided into two groups by a horizontal line at the

level of the termination of the great saphenous vein

y Those lying above this line are termed the superficial

inguinal glandsy Those below it the subinguinal glands

y Latter group consisting of a superficialand a deep set


23/31

Lymphatics of the Lower Limb


24/31

Lymphatics of the Lower Limby The Superficial InguinalGlands

y Form a chain immediately below the inguinal ligament

y Receive as afferents lymphatic vessels from theintegument of the penis, scrotum, perineum, buttock,and abdominal wall below the level of the umbilicus


25/31

Lymphatics of the Lower Limbsy The Superficial SubinguinalGlands

(lymphoglandul subinguinales superficiales)

yAre placed on either side of the upper part of the greatsaphenous vein;

y Their efferents consist chiefly of the superficiallymphatic vessels of the lower extremity

y Also receive some of the vessels which drain theintegument of the penis, scrotum, perineum, andbuttock


26/31

Lymphatics of the Lower Limby TheDeep Subinguinal Glands (lymphoglandul

subinguinales profund)

y Vary from one to three in number

y Are placed under the fascia lata, on the medial side of thefemoral vein

y .When three are present, the lowest is situated just belowthe junction of the great saphenous and femoral veins, the

middle in the femoral canal, and the highest in the lateralpart of the femoral ring

y Middle one is the most inconstant of the three, but thehighest, the gland of Cloquet or Rosenmller, is alsofrequently absent


27/31

Lymphatics of the Lower limby Lymphatic vessels of the lower limb

y Consist of two sets

y Superficial and deepy And in their distribution correspond closely with the

veins.


28/31

Lymphatics of the Lower Limby Superficial lymphatic vessels

y Lie in the superficial fascia

y Are divisible into two groupsy Medial,which follows the course of the great

saphenous vein

y Lateral,which accompanies the small saphenous vein.


29/31

Lymphatics of the Lower LimbyVessels of the medial group

y Are larger and more numerous than those of thelateral group

y Commence on the tibial side and dorsum of the foot

y Ascend both in front of and behind the medialmalleolus

y Run up the leg with the great saphenous vein

y Pass with it behind the medial condyle of the femur,and accompany it to the groin, where they end in thesubinguinal group of superficial glands


30/31

Lymphatics of the Lower LimbyVessels of the lateral group

y Arise from the fibular side of the foot

y Some ascend in front of the leg, and, just below theknee, cross the tibia to join the lymphatics on themedial side of the thigh

y Others pass behind the lateral malleolus, and,

accompanying the small saphenous vein, enter thepopliteal glands


31/31

Lymphatics of the Lower Limby Deep lymphatic vessels

y Are few in number

y Accompany the deep bloodvessels

y In the leg, they consist of three sets,

y the anterior tibial

y posterior tibial

yPeroneal

yWhich accompany the corresponding bloodvessels,two or three with each artery

y They enter the popliteal lymph glands

veins and lymphatics of the lower limbs and

Documents