5 Veins of the Upper Limb
Similar to the rest of the body, the upper limb is drained by a set
of deep and superficial veins. However, the veins of the upper
(and lower) limb contain valves, which assist, largely by the
­action of adjacent muscle contraction, to return venous blood to
the heart against gravity.
The deep set of veins of the upper limb parallel the arteries and
include the following major veins:
• Radial: parallels the deep radial artery in the lateral forearm
• Ulnar: parallels the ulnar artery in the medial forearm
• Brachial: formed by the union of the radial and ulnar veins in
the cubital fossa; this vein parallels the brachial artery in the
medial aspect of the arm
• Axillary: in the armpit, it parallels the axillary artery in the
­axillary sheath (surrounded by the cords of the brachial nerve
plexus)
• Subclavian: parallels the subclavian artery but passes anterior
to the anterior scalene muscle rather than posterior to it (artery
lies posterior)
The superficial set of veins of the upper limb are connected
by communicating veins to the deep set of veins and provide an
additional route for venous return to the heart. These veins can
vary considerably from person to person and have extensive
tributaries. The veins also have valves to assist in venous return
and include the following major veins:
• Dorsal venous network: most of the blood from the palm will
drain into these veins (especially when the hand is squeezed)
• Cephalic: runs in the subcutaneous tissue along the lateral
forearm and arm to ultimately drain into the axillary vein
• Basilic: runs in the subcutaneous tissue along the medial fore-
arm and distal arm to ultimately dive deep into the medial arm
and drain into the axillary vein
• Median cubital: passes from the cephalic to the basilic vein
in the cubital fossa and is a common site for venipuncture to
withdraw a blood sample or administer fluids intravenously
Plate 5-20
COLOR  the following veins of the upper limb, using a
different color for each vein:
n 1. Subclavian
n 2. Axillary
n 3. Cephalic (superficial)
n 4. Brachial
n 5. Median cubital (superficial)
n 6. Radial
n 7. Ulnar
n 8. Basilic (superficial)
Clinical Note:
In general, veins are more numerous than arteries, more variable
in their location, and often parallel arteries, especially deep
within the body or extremities. Veins of the limbs and those in
the lower neck (internal jugular veins) contain valves, whereas
most other veins in the body are valveless. Often, when a vein
such as the brachial or axillary vein parallels the artery of the
same name, the vein actually forms “venae comitantes” (accom-
panying veins), or a network of veins that entwines the parallel
artery like vines entwine a tree trunk. With several major excep-
tions, many veins may be sacrificed during surgery because so
many alternative venous channels exist to return blood from a
region back to the heart (of course, if venous repair is feasible,
it is preferred). Additionally, the body will usually “sprout” new
veins from adjacent tributaries to drain an area denuded of its
venous drainage.
Cardiovascular System
 Veins of the Upper Limb 5

Brachiocephalic veins Internal jugular vein

External jugular vein
1
Left subclavian vein

Superior vena cava

2

3
Azygos vein

5 Axillary vein
Subclavian vein
External jugular vein
Internal jugular vein
Brachiocephalic veins
8
Superior vena cava

Azygos vein
3 Median
cubital vein

6 7
Brachial vein

Cephalic
vein Median antebrachial vein
Deep palmar
venous arch Basilic vein
Ulnar vein
Superficial palmar Deep palmar venous arch
venous arch
Radial vein Metacarpal veins
Digital veins Superficial palmar venous arch
Digital veins

A. Veins of upper limb

B. Schematic of veins of upper limb

Netter’s Anatomy Coloring Book Plate 5-20

5 Veins of the Lower Limb
Similar to the rest of the body, the lower limb is drained by a set
of deep and superficial veins. However, the veins of the lower
(and upper) limb contain valves, which assist, largely by the
­action of adjacent muscle contraction, to return venous blood
to the heart against gravity.
The deep set of veins of the lower limb parallel the arteries and
include the following major veins:
• Posterior tibial: drains from the sole of the foot and medial
ankle superiorly up the leg, paralleling the posterior tibial artery
in the posterior compartment of the leg
• Anterior tibial: begins as the dorsalis pedis vein on the dor-
sum of the foot and parallels the anterior tibial artery in the
anterior compartment of the leg
• Fibular: small vein that parallels the artery of the same name in
the lateral compartment of the leg and drains into the posterior
tibial vein
• Popliteal: lies behind the knee and is formed by the anterior
and posterior tibial veins
• Femoral: the popliteal becomes the femoral in the distal thigh
and then the femoral drains deep to the inguinal ligament to
become the external iliac vein in the pelvis
The superficial set of veins of the lower limb are connected by
communicating veins to the deep set of veins and provide an
additional route for venous return to the heart. These veins can
vary considerably from person to person and have extensive
tributaries. The veins also have valves to assist in venous return
and include the following major veins:
• Dorsal venous arch: drains blood from the foot into the small
and large saphenous veins at the lateral and medial aspect of
the ankle, respectively
• Small saphenous: courses superiorly in the subcutaneous
tissue of the calf (posterior aspect of the leg) and then dives
deeply to drain into the popliteal vein behind the knee
• Great saphenous: courses superiorly from the medial side of
the ankle to run up the medial leg and thigh, draining into the
femoral vein just inferior to the inguinal ligament
Plate 5-21
Note that the great saphenous vein and the cephalic vein of the
upper limb are analogous veins, as are the small saphenous
and the basilic vein of the upper limb (both dive deeply to join a
deeper vein).
COLOR  the following veins of the lower limb, using a
different color for each vein:
n 1. Femoral
n 2. Great saphenous (superficial)
n 3. Anterior tibial
n 4. Popliteal
n 5. Small saphenous (superficial)
n 6. Posterior tibial
Clinical Note:
Veins of the extremities and those in the lower neck contain
valves. The valves are an extension of the tunica intima of the
venous wall, project into the vein’s lumen, and are similar in ap-
pearance to the semilunar valves of the heart. Venous valves as-
sist in venous return against gravity by preventing the backflow
of blood. The blood in the veins of the extremities is propelled
along, in part, by the contraction of adjacent skeletal muscle.
The walls of veins adjacent to the valves can become weakened
and distended, thus compromising the ability of the valve to
work properly and affecting venous return. Such veins are called
varicose (enlarged and tortuous) veins, and this condition is
most common in the veins of the lower limb.
Cardiovascular System
 Veins of the Lower Limb 5

A. Veins of lower limb: anterior view

Common iliac vein

Internal iliac vein Proximal

External iliac vein

Inguinal ligament Open

venous
valve

2
Muscle
B. Veins of leg and foot: posterior view contraction
squeezes blood
2 proximally
(open valve)
and distally
(closed valve)

4
Popliteal vein
Closed
venous
3
valve
Fibular
(peroneal) Fibular
vein (peroneal)
vein

5
3 Direction
of blood
flow in vein
6 Distal
Dorsalis pedis vein
C. Venous valves can assist
venous return against gravity
Plantar veins
Dorsalis pedis arch
Plantar arch

Metatarsal veins Digital veins

Netter’s Anatomy Coloring Book Plate 5-21