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Lesson # 34

TOPOGRAPHY AND DISTRIBUTION OF BRANCHES OF FEMORAL AND
POPLITEAL ARTERIES. ARTERIES OF LEG AND FOOT.
ANASTOMOSES BETWEEN THE ARTERIAL BRANCHES OF LOWER
EXTREMITY. SUPERFICIAL AND DEEP VEINS AND LYMPHATIC NODES AND
VESSELS OF LOWER EXTREMITY
THEME 1. TOPOGRAPHY AND DISTRIBUTION OF BRANCHES OF FEMORAL
AND POPLITEAL ARTERIES. ARTERIES OF LEG AND FOOT.
ANASTOMOSES BETWEEN THE ARTERIAL BRANCHES OF LOWER
EXTREMITY

Femoral artery is continuation of external iliac artery, which passes under inguinal ligament through
lacuna vasorum laterally from femoral vein. Then femoral artery runs downward in iliopectineal sulcus and
anterior femoral sulcus. It enters into adductorial canal and exits from canal in popliteal fossa where
contines into popliteal artery.

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three perforating arteries. deep femoral artery gives off medial circumflex femoral artery and lateral circumflexа artery.· · · · superficial epigastric artery passes on anterior abdominal wall and supplies a inferior portion of external oblique muscle aponeurosis and skin.com . superficial circumflexа iliac artery passes laterally and ramifies in muscles and skin near superior anterior iliac spina. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. passes through the tendinous hiatus of this canal and passes down together with saphenus nerve to knee-joint. where takes hand in formation of articulate knee net (rete articulare genus). descending genu artery begins from femoral artery in adductorial canal. that supply posterior group of thigh muscles.

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The femoral artery. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com .

passes in advance of tibial nerve and popliteal vein and on level of inferior margin of popliteal muscle divides into anterior tibial artery and posterior tibial artery.com .Popliteal artery is continuation of femoral artery. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.

· middle genu artery. All these arteries participate in feeding of knee-joint and muscles around it.Popliteal artery gives off the following branches: · superior medial and lateral genu arteries.com . open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. · inferior medial and lateral genu arteries.

Circumpatellar anastomosis.com . open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.

where subdivides into medial plantar artery and lateral plantar artery. behind medial malleolus.com . open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. passes in cruropopliteal canal.Posterior tibial artery continues from popliteal artery. passes in separate fibrous canal under flexors tendom retinaculum on sole. under musculus soleus.

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posterior tibial. Branches of posterior tibial artery: open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.The popliteal. and peroneal arteries.com .

· · · · fibular artery passes in inferior musculоfibular channel. supplies peroneal muscles and behind lateral malleolus divides into lateral maleolar branches and calcaneal branches. fibular circumflexа branch runs laterally from beginning of tibial artery and rounding a head of fibula joins to articulate knee net. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com . muscular branches supply deep and superficial muscles of posterior group in shin. medial malleolar branches take hand in formation of medial maleolar rete.

anastomosing with first dorsal metatarsal artery. which supply skin of both sides of each finger on sole. passes medially and. medial plantar artery is second terminal branches of posterior tibial artery (has a deep branch and superficial branch). open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. lies into medial plantar sulcus and supplies muscles of medial plantar group. anastomosing with deep plantar branch (from dorsal pedis artery). Lateral plantar artery gives off four plantar metatarsal arteries. lies in lateral plantar sulcus. which continue into common plantar digital arteries. forms plantar arc. Last subdivide into two proper plantar digital arteries.com .· · lateral plantar artery is a terminal branch of posterior tibial artery.

Superficial view. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com .The plantar arteries.

· anterior recurrent tibial artery takes hand in formation of articulate knee net. Artery lies on anterior surface of interossea membrane between muscles of anterior shin group and.· Anterior tibial artery begins from popliteal artery in popliteal fossa.com . · anterior medial maleolar artery takes hand in formation medial maleolar net. continues on foot under name of dorsal pedis artery. · muscular branches supply anterior shin muscles group. runs at cruropopliteal canal and makes perforating in superior portion of interossea membrane. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. passing under retinaculum of extensor muscles. Anterior tibial artery gives off the following branches: · posterior recurrent tibial artery takes hand in formation of articulate knee net.

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Anterior tibial and dorsalis pedis arteries.com . open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.

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com .SUPERFICIAL AND DEEP VEINS AND LYMPHATIC NODES AND VESSELS open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.

OF LOWER EXTREMITY The Veins of the Lower Extremity Just as with the upper extremity. V. passes gradually to the posterior surface of the artery. and as it rises higher. the veins of the lower extremity are divided into deep and superficial. it passes onto the medial surface. The veins flowing into v. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. femoralis is single.com . or subcutaneous. then. constitutes a single trunk lying in the popliteal fossa posteriorly and somewhat laterally of the artery of the same name. poplitea. veins. which pass independently of the arteries (Fig. From this position the vein runs under the inguinal ligament into the lacuna vasorum. it originates laterally of the femoral artery but. 63). femoralis are all binary. which is comprised of all the deep veins of the crus. V. The deep veins of the foot and crus are binary and they accompany arteries of the same name.

saphena magna and v. The long saphenous vein (vena saphena magna) originates on the dorsal surface of the foot from rete venosum dorsale pedis and the arcus venosus dorsalis pedis.com . saphena parva. Having received a few small open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.The largest of the subcutaneous veins of the lower extremity are two trunks: v.

branches from the side of the sole, it passes upward along the medial side of the crus and femur. In the
upper one-third of the femur, it bends onto the anteromedial surface and, lying on the broad fascia, runs
toward the hiatus saphenus. At this point, it drains into the femoral vein, passing over the lower horn of the
crescent-shaped edge. V. saphena magna

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quite often is binary with both its trunks draining separately into the femoral vein. Among the other
subcutaneous veins flowing into the femoral vein, mention should be made of v. epigastrica superficialis, v.
circumflex a ilium superficialis, and vv. pudendae externae, which accompany arteries of the same name.
Some of them drain directly into the femoral vein; others drain into v. saphena magna as it flows into the
region of the hiatus saphenus. The short saphenous vein (v. saphena parva) originates on the lateral side of
the dorsal surface of the foot, passes below and behind the lateral malleolus, and then rises along the
posterior surface of the crus. At first it runs along the lateral edge of Achilles’ tendon and then proceeds
upward along the middle of the posterior segment of the crus corresponding to the groove between the
heads of mm. gastrocnemii. When it reaches the lower angle of the popliteal fossa, v. saphena parva drains
into the popliteal vein. V. saphena parva is joined by branches to v. saphena magna.
DISTRIBUTION OF THE VEINS
1.

In the veins the blood flows through the greater part of the body (the trunk and limbs) against the

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force of gravity and, therefore, slower than in the arteries. The balance in the heart is achieved because
most of the venous bed is much wider than the arterial bed. The greater width of the venous bed is the
result of the following anatomical adaptations: the larger calibre of the veins, their greater number, the
paired attendance of the arteries, the presence of veins not accompanying arteries, the greater number of
anastomoses, the denser venous network, the formation of venous plexuses and sinuses, and the presence
of a portal system in the liver. Because of this, venous blood flows to the heart along three large vessels
(two venae cavae and the coronary sinus, in addition to the small veins running to the heart), while from the
heart blood flows only along the aorta.
2. Deep veins accompanying the arteries (venae commitantes) are distributed according to the same
laws as the arteries they accompany (see p. 93). Moreover, most of them accompany the arteries in pairs.
Where the venous outflow is most hampered, i.e., in the extremities, the veins are mainly paired, since this
arrangement is the result of evolution in four-legged animals whose torsos are horizontal, while both pairs
of limbs are perpendicular to the ground.
3. Many superficial veins lying under the skin accompany the nerves of the skin, although a significant
number form subcutaneous venous plexuses with no connection to either the nerves or the arteries.
4. Venous plexuses are mainly encountered in internal organs that change in volume in cavities with
inflexible walls. The plexuses facilitate the flow of venous blood when the organs increase in size and are
compressed by the walls. This explains the abundance of venous plexuses around the organs of the small
pelvis (urinary bladder, uterus, rectum), in the vertebral canal, where the pressure of the cerebrospinal fluid
constantly fluctuates, and in similar places.
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These spherical adaptations lie mainly where the processes of the dura mater are attached to the bones of the skull (at the seams of tegmental bones and bone sulci of analogous sinuses). 5. besides the veins. venae diploicae.In the cranial cavity where the slightest impediment to the venous outflow has an immediate effect on brain functions. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com . there are. Among the special adaptations are the diploic veins. 6. venous sinuses with inflexible walls formed by the dura mater.

the left subclavian vein (angulus venosus sinister). lymph flows into the venous paths not only where the lymphatic ducts join the large veins running to the heart. According to the latest data. An exchange of fluid between blood and lymph occurs in the nodes. Lymph flowing through these ducts. Forty per cent of the lymph (afferent) flowing into the node transfers into the venous paths of the lymph nodes. mixes with the blood flowing in the veins so that a mixture of venous blood and lymph flows into the heart.HAEMATO-LYMPHATIC RELATIONS As stated above. the thoracic duct drains into the left jugular vein or into the angle of its confluence with .com . but also in the lymph nodes. In phlebohypertonia the reverse phenomenon is observed in the drained organs: part of the blood plasma flows into the open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. therefore. while the right lymphatic duct drains into the right subclavian vein.

This reverse flow serves as one of the compensatory mechanisms in venous hypertension.lymphatic sinuses of the nodes. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com .

com . in turn. which. is determined by the adaptation of the respiratory organs open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.THE DEVELOPMENT OF LYMPHATIC VESSELS The development of the lymphatic system in the process of phylogenesis is closely related to the development of blood circulation.

The diffuse lymphatic tissue becomes concentrated in follicles located in the mucous membranes. the ductus thoracicus. At the same time the overall number of lymphatic vessels increases. There is no longer any need for the lymphatic hearts. a dilated lympthatic vessel that propels lymph into the venous bed. and they are situated in pairs on the border between the trunk and the extremities (anterior and posterior pairs). and they gradually disappear to be preserved only in a single (posterior) pair. 76). When gills are finally replaced by lungs in terrestrial animals and pulmonary circulation develops in addition to systemic circulation. At the same time.to the environment (Fig. and they disappear completely. With the appearance of a muscular diaphragm in mammals and the further development of the heart and blood vessels as well as the skeletal musculature.com . Valves appear inside the vessels. In birds lymphatic hearts are present only in the foetus. and muscles. and the lymphatic tissue is diffuse. In aquatic fauna (fish which breathe with gills and have a dual-chamber venous heart). in which many valves develop. increases. iymph is propelled by the pulsations of the lymphatic heart. Several lymph nodes make their appearance. the number of lymphatic vessels. As a result the role of lymphatic hearts diminishes. and the number of lymphatic vessels increases. The lymph ducts passing along the aorta merge into a large unpaired trunk. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. The number of lymph nodes increases sharply. In amphibians the number of lymphatic hearts increases. the movement of lymph is eased by the suction action of the thoracic cage and the contraction of the heart. preventing the reverse flow of lymph. Fish have no lymph nodes. particularly in primates. blood vessels. the movement of lymph is facilitated by the throbbing of the heart.

The lymphatic vessels of the head. the lymphatic system develops out of the venous system. theory contends that the system originates separately out of the mesenchyme and only later joins the veins. according to which the lymphatic system develops independently of the system of blood circulation and establishes connections with the venous system secondarily. as the first theory is called. Moreover. in their second month. According to the centrifugal development theory. the jugular sacs grow in the direction of the thoracic cavity and join in a single trunk. Humans have the greatest number of lymph nodes of any species.com . in comparison with monkeys) is connected with diet. The iliac sacs are the source for vessels of the lower limbs and pelvis. branch out. the number of valves in the lymphatic vessels of human extremities increases. The retroperitoneal S3C gives rise to vessels of the mesentery collecting lymph from the intestine. these capillaries. and form canals. form six lymph sacs: two by the jugular veins. The lymphatic system originates as detached germs. near the adrenals. which testifies to the increased importance of the lymphatic system in limiting the spread of pathological processes. Expanding and merging. one neighbouring the preceding one (this is the cisterna chyli). or lymph capillaries. which grow. and two by the iliac veins. There are two theories regarding the embryonic development of the lymphatic system. this theory is called the theory of centripetal development.Since human beings walk erect. Most authors currently recognize the latter theory. one retroperitoneal at the base of the mesentery. The second. neck. As a result a thoracic duct uniting the systems of open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. and upper extremity (these last from supplementary sacs occurring by the subclavian veins) develop from jugular sacs. which meets the growing cisterna chyli. particularly in the lower limbs. A Soviet scientist Zhdanov maintains that the increase of lymph nodes in man (even.

The deep lymphatic system of the soma is built as follows.com . of the soma) are divided into superficial and deep vessels. are superficial. because of the proximity to the venous half of the heart. but somewhat later (in the third month). This functional difference in the circulation through the right and left main lymph trunks of the body also explains their unequal development..the iliac. THE LYMPHATIC SYSTEM IN VARIOUS PARTS OF THE BODY The lymphatic vessels of the trunk. Thus. a single system of lymphatic vessels is created. Thus. there is a greater periodical increase of pressure in the vena cava superior as the result of heart contractions. Besides the lymphatic vessels and sacs. The initially symmetrical structure of the lymphatic system is disturbed later. A dual thoracic duct. subcutaneous tissue. because the left duct (thoracic) develops to a greater extent than the right. the lymphatic vessels of the skin. the lymph nodes also develop. common in lower vertebrates. This greater development is explained by the asymmetrical position of the heart and large veins which creates more favourable conditions for the flow of lymph and blood through the left side in the region of the left venous angle. i. the lymphatic vessels lying under the fascia. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. head. which makes contact with the venous system only near the jugular sacs at the confluence of the jugular and subclavian veins on both sides of the body. separated by the deep fascia of the given region. On the right side. while all other vessels. and part of the fascia.e. and limbs (i. which hampers the stream of lymph from freely joining the flow of venous blood. are deep. retroperitoneal and jugular sacs is formed.e. however. is sometimes preserved as a developmental variant in humans..

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THE LOWER EXTREMITY The lymph nodes of the lower extremity are located in the following places (Fig.com . open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. tendons. muscles. as components of the neurovascular bundles of these organs and then drain into the lymph collectors of the given part of the body. and so on run.The deep lymphatic vessels arising from the capillary lymph networks of joint capsules. nerves. at first. In their turn the lymph collectors accompany large arterial and venous trunks and drain into the regional lymph nodes. fasciae. 77).

com . Popliteal fossa—popliteal lymph glands (nodi lymphatici poplitet). Inguinal region—inguinal lymph glands (nodi lymphatici inguinales). open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.1. a) superficial inguinal glands (nodi lymphatici inguinales superficiales) are located on the wide fascia 2. They lie immediately under the inguinal ligament and are divided into superficial and deep inguinal lymph glands.

of the femur below its perforation by v. saphena magna. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com .

com . open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.b)deep inguinal glands (nodi lymphatici.inguinales profundi) are locatea in the same region as the superficial glands although under the wide fascir.

com . saphena parva to the open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.The superficial lymphatic vessels drain into two groups of collect os running the length of v. saphena magna to the medial group of the superficial inguinal nodes and along v.

From all other parts of the leg.com . the lymph flows into the medial group of collectors and then into the inguinal nodes without interruption in the popliteal nodes. receive lymph from the skin. the lateral edge of the foot. and the lateral part of the gastrocnemius region). The posterolateral group of collectors and the popliteal nodes. and superficial fasciae of a small region of the leg (the fourth and fifth toes. the inferior lateral surface of the crus. subcutaneous tissue. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.popliteal nodes of the posterolateral group.

the anterior abdominal wall.This explains the reaction of the inguinal nodes (tumescence and tenderness) in purulent inflammation of the skin of the ungual phalanx of the big toe. for example.com . The superficial lymphatic vessels of the upper one-third of the thigh drain into the inguinal nodes. and the external sexual organs. which also receive the superficial vessels of the gluteal region. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.

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com . the gluteal region. From there the lymph flows through the deep collectors attendant to the femoral artery until it reaches the deep inguinal nodes. including the articular sac of the knee joint. drain into the popliteal nodes.The deep lymphatic vessels of the foot and crus. the large group of nodes located in the inguinal region collects lymph from the entire lower limb. These same collectors also receive lymph from the deep tissues of the thigh. As a result. the anterior wall of the abdomen (below the navel). the perineum and external sexual organs. and partly from the internal sexual organs (uterus). open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.

sacralis mediana. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. their efferent ducts run towards nodi lymphatici iliaci. as well as on the surface of the internal organs. 3) sacral lymph glands (nodi lymphatici sac. THE PELVIS In the pelvis the lymph nodes are mainly located along the blood vessels. 2) internal iliac lymph glands (nodi lymphatici iliaci interni) (9-12) on the lateral wall of the pelvic cavity. their efferent ducts are directed towards nodi lymphatici lumbales. The following groups are found there: 1) external and common iliac lymph glands (nodi lymphatici iliaci externi and commune) along the external artery and the common iliac artery. 77).The efferent vessels of the inguinal nodes run the length of the external iliac artery and vein to the iliac lymph nodes from where the lymph passes into the truncus lumbalis.rales). located near the promontorium.com . their efferent ducts pass to the nodes located along the common iliac artery. The efferent lymphatic vessels of the organs of the minor pelvis drain into these nodes (see also the section on splanchnology) (Fig. small nodes along a.

External iliac vein is continuation of femoral vein and receives blood from all veins of lower limb.com . Inferior epigastric vein and deep circumflexа ilei vein empties into external iliac vein under inguinal ligament. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.

com .The veins of lower limb subdivide into superficial and deep. Follow veins belong to superficial veins of lower limb: open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. Deep veins are double and accompany same name artery (only a popliteal vein and femoral vein are odd).

Vena saphena magna has the numerous subcutaneous tributaries from anteromedial surface of leg. passes along saphenus nerve on medial leg surface upward. than on medial surface on thigh to saphaenus hiatus. thigh and external genitals.com . Vena saphena magna has numerous valves. where transfixes cribriform fascia and empties into femoral vein. where receives influxes from plantar surface of foot. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.1. starts in front of medial malleolus.

com .2. Vena saphena parva has the numerous valves and collects blood from dorsal venous arch of foot. lies into sulcus between lateral and medial heads of gastrocnemius muscle and in popliteal fossa empties into popliteal vein. passes behind lateral malleolus. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.

· fibular veins. Follow vessels belong to deep veins of lower limb: · femoral vein. The Superficial Veins of the Lower Extremity The superficial veins of the lower extremity are the great and small saphenous veins and their open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. · deep femoral vein.com . · popliteal vein. · posterior tibial veins. · anterior tibial veins. 3.The great saphenous vein and its tributaries at the fossa ovalis.

com . On the dorsum of the foot the dorsal digital veins receive. in the clefts between the toes.tributaries. the intercapitular veins from the plantar cutaneous venous arch and join to form short common digital open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.

The great saphenous vein (v. this net-work communicates with the cutaneous venous arch and with the deep veins. but is chiefly drained into the medial and lateral marginal veins. those from the medial and posterior parts of the thigh frequently unite to form a large accessory saphenous vein which joins the main vein at a variable level. the longest vein in the body. It runs upward behind the medial condyles of the tibia and femur and along the medial side of the thigh and. begins in the medial marginal vein of the dorsum of the foot and ends in the femoral vein about 3 cm. Proximal to this arch is a plantar cutaneous venous net-work which is especially dense in the fat beneath the heel. in the thigh it communicates with the femoral vein and receives numerous tributaries. Near the fossa ovalis open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. internal or long saphenous vein) (581). in the leg it anastomoses freely with the small saphenous vein. ends in the femoral vein. On the sole of the foot the superficial veins form a plantar cutaneous venous arch which extends across the roots of the toes and opens at the sides of the foot into the medial and lateral marginal veins. saphena magna. formed mainly by the union of branches from the superficial parts of the sole of the foot.com . communicates with the anterior and posterior tibial veins and receives many cutaneous veins. Proximal to this arch is an irregular venous net-work which receives tributaries from the deep veins and is joined at the sides of the foot by a medial and a lateral marginal vein. It ascends in front of the tibial malleolus and along the medial side of the leg in relation with the saphenous nerve.—At the ankle it receives branches from the sole of the foot through the medial marginal vein. passing through the fossa ovalis.veins which unite across the distal ends of the metatarsal bones in a dorsal venous arch. below the inguinal ligament. Tributaries.

Before it pierces the deep fascia. it perforates the deep fascia in the lower part of the popliteal fossa. one of which is always found near its termination in the popliteal vein. Running directly upward.(580) it is joined by the superficial epigastric. in the upper two-thirds with the medial sural cutaneous nerve. In the lower third of the leg the small saphenous vein is in close relation with the sural nerve. saphena parva.com . superficial iliac circumflex. they are more numerous in the leg than in the thigh. it first ascends along the lateral margin of the tendocalcaneus. The Deep Veins of the Lower Extremity The deep veins of the lower extremity accompany the arteries and their branches. The small saphenous vein (v. runs along the lateral aspect of the trunk between the superficial epigastric vein below and the lateral thoracic vein above and establishes an important communication between the femoral and axillary veins. and ends in the popliteal vein. It communicates with the deep veins on the dorsum of the foot. A vein. they possess numerous open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. The small saphenous vein possesses from nine to twelve valves. and then crosses it to reach the middle of the back of the leg. between the heads of the Gastrocnemius. it gives off a branch which runs upward and forward to join the great saphenous vein. and superficial external pudendal veins. named the thoracoepigastric. The valves in the great saphenous vein vary from ten to twenty in number. and receives numerous large tributaries from the back of the leg. external or short saphenous vein) (582) begins behind the lateral malleolus as a continuation of the lateral marginal vein.

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com .The great saphenous vein and its tributaries. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.

com .The small saphenous vein. digitales plantares) arise from plexuses on the plantar surfaces of the open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. The plantar digital veins (vv.

They leave the front of the leg by passing between the tibia and fibula. tibiales posteriores) accompany the posterior tibial artery. by means of perforating veins. these run backward in the metatarsal spaces. and unite to form the deep plantar venous arch which lies alongside the plantar arterial arch. where it becomes the femoral vein. communicate. unite to form four metatarsal veins. between the heads of the Gastrocnemius it is superficial to that vessel. From the deep plantar venous arch the medial and lateral plantar veins run backward close to the corresponding arteries and. In the lower part of its course it lies lateral to the artery. to form the popliteal vein. poplitea) (583) is formed by the junction of the anterior and posterior tibial veins at the lower border of the Popliteus. It receives numerous muscular tributaries. it is behind it. after communicating with the great and small saphenous veins. after sending intercapitular veins to join the dorsal digital veins. and it also receives the small saphenous vein. higher up. and open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. unite behind the medial malleolus to form the posterior tibial veins. The femoral vein (v. The anterior tibial veins (vv. and unite with the posterior tibial. The valves in the popliteal vein are usually four in number. femoralis) accompanies the femoral artery through the upper two-thirds of the thigh. over the interosseous membrane. with the veins on the dorsum of the foot. it lies on its medial side. it is close to its lateral side. In the lower part of its course it is placed medial to the artery. The Popliteal Vein (v.digits. The posterior tibial veins (vv. but above the knee-joint. It receives tributaries corresponding to the branches of the popliteal artery. and at the inguinal ligament. and. it ascends through the popliteal fossa to the aperture in the Adductor magnus. and are joined by the peroneal veins.com . tibiales anteriores) are the upward continuation of the venæ comitantes of the dorsalis pedis artery. and on the same plane.

It also receives the medial and lateral femoral circumflex veins. profunda femoris) receives tributaries corresponding to the perforating branches of the profunda artery. below the inguinal ligament is joined by the v. The Veins of the Abdomen and Pelvis (585. profunda femoris. 586.com . 587) open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. The Deep Femoral Vein (v. and through these establishes communications with the popliteal vein below and the inferior gluteal vein above. near its termination it is joined by the great saphenous vein. The popliteal vein. The valves in the femoral vein are three in number.about 4 cm.

it lies at first medial to the artery: but.The external iliac vein (v. gradually inclines behind it. circumflexa ilium profunda) is formed by the union of the venæ comitantes of the deep iliac circumflex artery. above the inguinal ligament. the upward continuation of the femoral vein. epigastrica inferior. The hypogastric vein (v. and pubic veins.com . by uniting with the hypogastric vein to form the common iliac vein. valves. It frequently contains one. The Inferior Epigastric Vein (v. passes upward behind and slightly medial to the hypogastric artery and. which communicate above with the superior epigastric vein. iliaca externa). The Deep Iliac Circumflex Vein (v. Tributaries. The Pubic Vein communicates with the obturator vein in the obturator foramen. above the inguinal ligament.—The external iliac vein receives the inferior epigastric. On the left side. On the right side. joins with the external iliac to form the common iliac vein. ends opposite the sacroiliac articulation. as it passes upward. passing upward along the brim of the lesser pelvis. and joins the external iliac vein about 2 cm. internal iliac vein) begins near the upper part of the greater sciatic foramen. it lies altogether on the medial side of the artery. and. hypogastrica. sometimes two. deep iliac circumflex. it joins the external iliac about 1. begins behind the inguinal ligament. at the brim of the pelvis. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. and ascends on the back of the pubis to the external iliac vein.25 cm. deep epigastric vein) is formed by the union of the venæ comitantes of the inferior epigastric artery.

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internal pudendal. vesical. and (c) the middle hemorrhoidal. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. (b) the lateral sacral veins.—With the exception of the fetal umbilical vein which passes upward and backward from the umbilicus to the liver. It receives (a) the gluteal. Tributaries. and the iliolumbar vein which usually joins the common iliac vein. which have their origins outside the pelvis. and vaginal veins. and obturator veins. the tributaries of the hypogastric vein correspond with the branches of the hypogastric artery. which lie in front of the sacrum. uterine.com . which originate in venous plexuses connected with the pelvic viscera.The femoral vein and its tributaries.

The Lymphatics of the Lower Extremity open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com .

These vessels beneath knee join to medial group. The superficial vessels are situated over superficial fascia and deep vessels positioned closely to deep blood vessels. nerves. The superficial vessels of lower limb formed from capillary skin networks and subcutaneous cellular tissue and form medial. Medial group of superficial vessels formed in skin of I. II and III fingers. The Veins of the Lower Extremity Just as with the upper extremity. or subcutaneous. joints. The deep veins of the foot and crus are binary and they accompany arteries of the same name. Posterior group of superficial vessels of lower limb starts in skin of heel and plantar surface of lateral foot margin. veins. Popliteal nodes and inguinal nodes are distinguished in lower limb. synovial sheaths. which accompany same name artery. V. These vessels run along vena saphena magna and empty into superficial inguinal nodes.The superficial and deep vessels are distinguished in lower limb. bones. accompany deep arteries and veins and empty into deep inguinal nodes. which pass independently of the arteries . passes along the vena saphaena parva and runs into popliteal lymphatic nodes. Superficial inguinal nodes dispose along inguinal ligament and lie on superficial sheet of fascia lata femoris. Deep vessels of lower limb drainage muscles. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. Lateral group of superficial vessels of lower limb formed laterally in area of fingers in dorsal foot surface and lateral surface of shin.com . lateral and posterior vessel groups. Last one subdivide into deep inguinal nodes and superficial inguinal nodes. the veins of the lower extremity are divided into deep and superficial. medial part of foot and medial surface of shin. Their efferent vessels pass to external iliac nodes.

From this position the vein runs under the inguinal ligament into the lacuna vasorum. and as it rises higher. The veins flowing into v. it originates laterally of the femoral artery but. constitutes a single trunk lying in the popliteal fossa posteriorly and somewhat laterally of the artery of the same name. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. it passes onto the medial surface.poplitea. V. then. which is comprised of all the deep veins of the crus. femoralis is single.com . femoralis are all binary. passes gradually to the posterior surface of the artery.

The long saphenous vein (vena saphena magna) originates on the dorsal surface of the foot from rete venosum dorsale pedis and the arcus venosus dorsalis pedis. it drains into the femoral vein. V. runs toward the hiatus saphenus. At this point.The largest of the subcutaneous veins of the lower extremity are two trunks: v. In the upper one-third of the femur. lying on the broad fascia. saphena magna open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com . it bends onto the anteromedial surface and. passing over the lower horn of the crescent-shaped edge. it passes upward along the medial side of the crus and femur. Having received a few small branches from the side of the sole. saphena magna and v. saphena parva.

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open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. Among the other subcutaneous veins flowing into the femoral vein. and then rises along the posterior surface of the crus. V. saphena parva is joined by branches to v. saphena parva drains into the popliteal vein. which accompany arteries of the same name. v.quite often is binary with both its trunks draining separately into the femoral vein. saphena magna. circumflex a ilium superficialis. When it reaches the lower angle of the popliteal fossa. The short saphenous vein (v. saphena parva) originates on the lateral side of the dorsal surface of the foot. gastrocnemii. v. passes below and behind the lateral malleolus.com . epigastrica superficialis. mention should be made of v. and vv. saphena magna as it flows into the region of the hiatus saphenus. At first it runs along the lateral edge of Achilles’ tendon and then proceeds upward along the middle of the posterior segment of the crus corresponding to the groove between the heads of mm. Some of them drain directly into the femoral vein. pudendae externae. others drain into v.

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the formation of venous plexuses and sinuses. Moreover. the denser venous network. 2. The greater width of the venous bed is the result of the following anatomical adaptations: the larger calibre of the veins. therefore. most of them accompany the arteries in pairs. and the presence of a portal system in the liver. 93).com . the greater number of anastomoses. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. Deep veins accompanying the arteries (venae commitantes) are distributed according to the same laws as the arteries they accompany (see p. their greater number. venous blood flows to the heart along three large vessels (two venae cavae and the coronary sinus. the presence of veins not accompanying arteries. The balance in the heart is achieved because most of the venous bed is much wider than the arterial bed. Because of this. 1. in addition to the small veins running to the heart). slower than in the arteries. while from the heart blood flows only along the aorta.DISTRIBUTION OF THE VEINS In the veins the blood flows through the greater part of the body (the trunk and limbs) against the force of gravity and. the paired attendance of the arteries.

rectum). venous sinuses with inflexible walls formed by the dura mater. This explains the abundance of venous plexuses around the organs of the small pelvis (urinary bladder.e. since this arrangement is the result of evolution in four-legged animals whose torsos are horizontal. In the cranial cavity where the slightest impediment to the venous outflow has an immediate effect on brain functions. the veins are mainly paired. venae diploicae. Many superficial veins lying under the skin accompany the nerves of the skin. and in similar places. where the pressure of the cerebrospinal fluid constantly fluctuates.the left subclavian vein (angulus venosus sinister). Venous plexuses are mainly encountered in internal organs that change in volume in cavities with inflexible walls. uterus. while the right lymphatic duct drains into the right open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. 6. although a significant number form subcutaneous venous plexuses with no connection to either the nerves or the arteries. Among the special adaptations are the diploic veins. HAEMATO-LYMPHATIC RELATIONS As stated above. The plexuses facilitate the flow of venous blood when the organs increase in size and are compressed by the walls. 3. the thoracic duct drains into the left jugular vein or into the angle of its confluence with . These spherical adaptations lie mainly where the processes of the dura mater are attached to the bones of the skull (at the seams of tegmental bones and bone sulci of analogous sinuses). in the vertebral canal. in the extremities. 5. i. there are.com . besides the veins. while both pairs of limbs are perpendicular to the ground.Where the venous outflow is most hampered.. 4.

but also in the lymph nodes. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com . According to the latest data. in turn. In phlebohypertonia the reverse phenomenon is observed in the drained organs: part of the blood plasma flows into the lymphatic sinuses of the nodes. therefore. An exchange of fluid between blood and lymph occurs in the nodes. 76). which. In aquatic fauna (fish which breathe with gills and have a dual-chamber venous heart). In amphibians the number of lymphatic hearts increases. Fish have no lymph nodes. mixes with the blood flowing in the veins so that a mixture of venous blood and lymph flows into the heart. a dilated lympthatic vessel that propels lymph into the venous bed. This reverse flow serves as one of the compensatory mechanisms in venous hypertension. and they are situated in pairs on the border between the trunk and the extremities (anterior and posterior pairs). iymph is propelled by the pulsations of the lymphatic heart. lymph flows into the venous paths not only where the lymphatic ducts join the large veins running to the heart. is determined by the adaptation of the respiratory organs to the environment (Fig. Forty per cent of the lymph (afferent) flowing into the node transfers into the venous paths of the lymph nodes. The diffuse lymphatic tissue becomes concentrated in follicles located in the mucous membranes. and the lymphatic tissue is diffuse. Lymph flowing through these ducts. THE DEVELOPMENT OF LYMPHATIC VESSELS The development of the lymphatic system in the process of phylogenesis is closely related to the development of blood circulation.subclavian vein.

and they gradually disappear to be preserved only in a single (posterior) pair. increases. At the same time the overall number of lymphatic vessels increases. the lymphatic system develops out of the open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. the number of lymphatic vessels. In birds lymphatic hearts are present only in the foetus. the movement of lymph is facilitated by the throbbing of the heart. The lymph ducts passing along the aorta merge into a large unpaired trunk. in comparison with monkeys) is connected with diet. and they disappear completely. A Soviet scientist Zhdanov maintains that the increase of lymph nodes in man (even. which testifies to the increased importance of the lymphatic system in limiting the spread of pathological processes. particularly in the lower limbs. With the appearance of a muscular diaphragm in mammals and the further development of the heart and blood vessels as well as the skeletal musculature. the number of valves in the lymphatic vessels of human extremities increases. Valves appear inside the vessels. and muscles. Several lymph nodes make their appearance. the ductus thoracicus. At the same time. The number of lymph nodes increases sharply. There are two theories regarding the embryonic development of the lymphatic system.When gills are finally replaced by lungs in terrestrial animals and pulmonary circulation develops in addition to systemic circulation. in which many valves develop. blood vessels.com . As a result the role of lymphatic hearts diminishes. Since human beings walk erect. particularly in primates. There is no longer any need for the lymphatic hearts. and the number of lymphatic vessels increases. the movement of lymph is eased by the suction action of the thoracic cage and the contraction of the heart. Humans have the greatest number of lymph nodes of any species. as the first theory is called. preventing the reverse flow of lymph. According to the centrifugal development theory.

theory contends that the system open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.venous system. The second.com .

in their second month. and upper extremity (these last from supplementary sacs occurring by the subclavian veins) develop from jugular sacs. according to which the lymphatic system develops independently of the system of blood circulation and establishes connections with the venous system secondarily. branch out. The retroperitoneal S3C gives rise to vessels of the mesentery collecting lymph from the intestine. the jugular sacs grow in the direction of the thoracic cavity and join in a single trunk.originates separately out of the mesenchyme and only later joins the veins. and form canals. The lymphatic system originates as detached germs. these capillaries. Moreover. retroperitoneal and jugular sacs is formed. one retroperitoneal at the base of the mesentery. As a result a thoracic duct uniting the systems of the iliac. a single system of lymphatic vessels is created. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd. which makes contact with the venous system only near the jugular sacs at the confluence of the jugular and subclavian veins on both sides of the body. Most authors currently recognize the latter theory. form six lymph sacs: two by the jugular veins. which grow. and two by the iliac veins. neck. this theory is called the theory of centripetal development. The iliac sacs are the source for vessels of the lower limbs and pelvis. or lymph capillaries. which meets the growing cisterna chyli. one neighbouring the preceding one (this is the cisterna chyli).com . Expanding and merging. The lymphatic vessels of the head. Thus. near the adrenals.

is sometimes preserved as a developmental variant in humans. are superficial.The initially symmetrical structure of the lymphatic system is disturbed later. This functional difference in the circulation through the right and left main lymph trunks of the body also explains their unequal development. are deep.. tendons. The deep lymphatic vessels arising from the capillary lymph networks of joint capsules. because of the proximity to the venous half of the heart. nerves. separated by the deep fascia of the given region. subcutaneous tissue. and limbs (i. common in lower vertebrates. at first. Besides the lymphatic vessels and sacs. Thus. while all other vessels. the lymph nodes also develop. muscles.. In their turn the lymph collectors accompany large arterial and venous trunks and drain into the regional lymph nodes. but somewhat later (in the third month). and so on run. there is a greater periodical increase of pressure in the vena cava superior as the result of heart contractions. head. This greater development is explained by the asymmetrical position of the heart and large veins which creates more favourable conditions for the flow of lymph and blood through the left side in the region of the left venous angle. THE LYMPHATIC SYSTEM IN VARIOUS PARTS OF THE BODY The lymphatic vessels of the trunk. the lymphatic vessels lying under the fascia. because the left duct (thoracic) develops to a greater extent than the right. A dual thoracic duct. and part of the fascia. of the soma) are divided into superficial and deep vessels. The deep lymphatic system of the soma is built as follows. fasciae.e. as components of the neurovascular bundles of these organs and then drain into the lymph collectors of the given part of the body.com . however. On the right side. THE LOWER EXTREMITY open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.e. which hampers the stream of lymph from freely joining the flow of venous blood. i. the lymphatic vessels of the skin.

THE LOWER EXTREMITY
The lymph nodes of the lower extremity are located in the following places (Fig. 77).
1. Popliteal fossa—popliteal lymph glands (nodi lymphatici poplitet).

Inguinal region—inguinal lymph glands (nodi lymphatici inguinales). They lie immediately under the
inguinal ligament and are divided into superficial and deep inguinal lymph glands.
2.

a)superficial inguinal glands

(nodi lymphatici inguinales superficiales) are located on the wide fascia
of the femur below its perforation by v. saphena magna;
b)deep

inguinal glands (nodi lymphatici.inguinales profundi) are locatea in the same region as the
superficial glands although under the wide fascir.
The superficial lymphatic vessels drain into two groups of collect os running the length of v.
saphena magna to the medial group of the superficial inguinal nodes and along v. saphena parva to the
popliteal nodes of the posterolateral group.
The posterolateral group of collectors and the popliteal nodes, receive lymph from the skin,
subcutaneous tissue, and superficial fasciae of a small region of the leg (the fourth and fifth toes, the lateral
edge of the foot, the inferior lateral surface of the crus, and the lateral part of the gastrocnemius region).
From all other parts of the leg, the lymph flows into the medial group of collectors and then into the
inguinal nodes without interruption in the popliteal nodes. This explains the reaction of the inguinal nodes
(tumescence and tenderness) in purulent inflammation of the skin of the ungual phalanx of the big toe, for
example. The superficial lymphatic vessels of the upper one-third of the thigh drain into the inguinal nodes,
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which also receive the superficial vessels of the gluteal region, the anterior abdominal wall, and the external
sexual organs.
The deep lymphatic vessels of the foot and crus, including the articular sac of the knee joint, drain into
the popliteal nodes. From there the lymph flows through the deep collectors attendant to the femoral artery
until it reaches the deep inguinal nodes. These same collectors also receive lymph from the deep tissues of
the thigh. As a result, the large group of nodes located in the inguinal region collects lymph from the entire
lower limb, the anterior wall of the abdomen (below the navel), the gluteal region, the perineum and external
sexual organs, and partly from the internal sexual organs (uterus).
The efferent vessels of the inguinal nodes run the length of the external iliac artery and vein to the iliac
lymph nodes from where the lymph passes into the truncus lumbalis.

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THE PELVIS
In the pelvis the lymph nodes are mainly located along the blood vessels, as well as on the surface of
the internal organs. The following groups are found there: 1) external and common iliac lymph glands (nodi
lymphatici iliaci externi and commune) along the external artery and the common iliac artery; their efferent
ducts are directed towards nodi lymphatici lumbales; 2) internal iliac lymph glands (nodi lymphatici iliaci
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their efferent ducts pass to the nodes located along the common iliac artery.com . The efferent lymphatic vessels of the organs of the minor pelvis drain into these nodes. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.rales).interni) (9-12) on the lateral wall of the pelvic cavity. located near the promontorium. sacralis mediana. 3) sacral lymph glands (nodi lymphatici sac. small nodes along a. their efferent ducts run towards nodi lymphatici iliaci.