ANATOMY AND PHYSIOLOGY

OF VENOUS SYSTEM

MUHAMMAD SIDIQ BIN SHIHABUDIN

 CONTENT
❑ANATOMY OF VENOUS SYSTEM
o Superficial venous system
o Deep venous systems
o Perforators veins

❑PHYSIOLOGY OF VENOUS BLOOD FLOW

 Superficial Venous System
Great Saphenous Vein
Longest vein in the body and most frequently affected by
superficial incompetence

Arise from medial side of dorsal venous arch Through-out the

course the GSV unites
↓ variably with other
Passes anterior to medial malleolus superficial tributaries
↓
Looping posteriorly at the level of medial condyle of femur
↓
Continuing in medial thigh
↓
Unites with tributaries: venous from arterial branches of common femoral
artery. ↓
reach saphenous opening where it pierces the cribriform fascia
(approximately 2.5cm lateral and inferior to pubic tubercle)
↓
Drain into common femoral vein at Sapheno-femoral junction

❖Superficial iliac circumflex vein
❖Superficial epigastric veins
❖Superficial external pudendal vein
❖Posteromedial vein
❖Anterolateral vein
Tributaries of GSV
• Saphenofemoral junction is a sophisticated
structure comprising of the arch of great
saphenous vein, terminal and pre- terminal
valves plus a number of tributaries.
• In the thigh near the saphenofemoral
junction, the great saphenous vein
receives posteromedial and anterolateral
veins
• The deep external pudendal vein,
superficial epigastric vein, superficial
circumflex iliac vein and superficial
external pudendal vein enter the great
saphenous vein at the fossa ovalis.
Arise at dorsum of the foot from the dorsal venous arch at the Superficial Venous System
lateral aspect
↓
Small Saphenous Vein
Ascend posterior to the lateral malleolus
↓
Then, ascend upward in the posterior midline of the leg
↓
continues until the lower part of popliteal fossa - between two
heads of gastrocnemius
↓
Piercing the deep fascia of the popliteal fossa
↓
Terminate occur at saphenopopliteal junction
↓
Drain into popliteal veins

Sural nerve travels along with SSV

 Communicating Vein of
Superficial Venous System
Dorsal metatarsal veins

Dorsal venous arch

Medial end Lateral side

Giacomini
Great saphenous veins Small saphenous veins
vein

sphenofemoral The thigh sphenopopliteal

junction extension of small junction
saphenous vein

Common Femoral vein Popliteal vein

 plantar digit veins

Deep Venous System Network of metatarsal vein, that

compose the deep plantar venous
arch
Medial plantar Lateral plantar
veins veins

Paired posterior tibial veins

Soleal sinus Run under the fascia of deep
(large venous sinuses posterior compartment
within the soleus Dorsalis pedis veins on
muscle) the dorsum of the foot
Enter soleus muscle
Formed paired
Paired peroneal veins Join together in the popliteal fossa anterior tibial vein at
the ankle

Bilateral
Small saphenous vein Popliteal veins gastrocnemius veins
 Popliteal veins

Deep Pass through adductor hiatus to enter the sub-satorial canal

Venous Femoral vein

System In the femoral triangle

Receives venous drainage from profunda

(deep) femoral veins

Common femoral vein

Cross behind inguinal ligament

External iliac veins

Schematic
Flowchart
Anterior
and
Posterior
Veins
 Venous System Perforator
• Perforating veins connect the superficial venous system to the deep venous
system by penetrating the fascial layers of the lower extremity.
• These perforators run in perpendicular fashion to the axial veins
• Up to 100 have been documented
• Important function: their valve system aids in preventing reflux from the
deep to superficial system, particularly during periods of standing and
ambulation
Perforator veins Connection Site

Crockett Connect posterior Inferior part of

perforators arch and posterior the inferior 2/3
tibial veins tibia

Boyd perforators Connect great At or below the

saphenous and knee level
gastrocnemius
veins
Dodd perforators Connect great Inferior 1/3 of the
saphenous and thigh , above the
superficial knee
femoral veins

Hunter Connect great Proximal thigh

perforators saphenous and
superficial
femoral veins
 Venous Pathophysiology
❖ two principal functions of veins:
❑ to act as conduit vessels, transporting blood back to the heart from the
body’s organs and tissues (i.e., the venous return)
❑ to act as capacitance vessels, accommodating large volumes of blood
❖ At rest, the venous structures contain approximately two-thirds of the total
blood volume and thus act as a blood reservoir
❖ When standing from a supine position, gravitational forces “pull” venous
blood to the lower limbs
❖ Due to the high compliance of veins, ~500 ml of blood can be redistributed to
peripheral veins; this is known as venous pooling
❖ This venous pooling leads to an immediate drop in stroke volume of 40% and
an overall drop in cardiac output of 20%
❖ The veins below the right atrium are exposed to positive hydrostatic pressure
and are distended by the pressure within them
❖ The greater the distance from the right atrium, the greater the column of blood
and, therefore, the greater the pressure, with it being highest in the feet
❖ The venous pressure in a foot vein on standing is equivalent to the height
of column of blood extending from the heart to the foot (approximately 100
mmHg)
❖ To enable blood to be returned against gravity in the
standing position a pressure gradient must exist
between the veins in the leg and the chest
❖ This gradient is created in two ways:
1. ↑ thoracic volume during inspiration, ↓
intra-thoracic pressure
2. Compression by the surrounding muscles
(the ‘calf muscle pump’) → ↑ pressure in the
veins of the leg, pushing open the proximal
valve and forcing blood towards heart
❖Tone of venous walls
⮚When the muscles relax, the distal valve closes
as the retrograde flow presses against the valve
leaflets, and blood from distal veins is sucked
into the empty muscle veins
❖ Absence of one or more of these result in venous
hypertension → vein wall damage (loss of
compliance, thickening, dilatation and valvular
dysfunction)
Reference