Anatomy: Femoral vein. Veins of the lower extremity: types, anatomical features, functions The vein is a continuation of the femoral vein

Many people confuse the concepts of veins and arteries. Let's see how these two elements of the human circulatory system differ from each other before moving on to an overview of a specific part of it.

Heart

The central organ of the human vascular system is the heart, on which tubes of different sizes and diameters, the so-called blood vessels, are closed. By rhythmically contracting, it pumps the blood inside the body. Arteries are the vessels that carry blood from the heart to peripheral organs, while veins carry blood back to the heart. This is the main difference. Venous and arterial bleeding differ in characteristic features: at the first, the blood flows in a stream, and at the second it gushes.

Arteries and veins

There are several fundamental differences between arteries and veins:

1. Arteries carry blood to organs from the heart, veins - in the opposite direction. in the first case oxygen is transported through the vessels, and in the second - carbon dioxide.
2. Arterial walls are thicker and more elastic than veins. The blood in them moves under pressure. The flow in the veins is much calmer.
3. There are twice as many veins than arteries, and their location is more superficial.
4. In the medical field, veins are used to collect materials for analyzes, not arteries.

This article will discuss the femoral vein.

Venous networks

To carry out the correct diagnosis of the disease and the correct diagnosis in the field of venous diseases, it is necessary to clearly understand the blood vessel system of the lower extremities. The deep and superficial vein network is distinguished. The deep one consists of paired vessels passing next to the arteries on the fingers, foot and lower leg. The tibial veins converge in the femoral-popliteal canal and create an unpaired popliteal vein that passes into the femoral vein. Up to 8 peripheral vessels are attached to it before going into the ileum. In addition to them, a deep vein also adds, carrying blood cells from the back of the thigh.

The superficial circulatory system is located directly under the skin. It consists of a large and small saphenous vein, respectively.

Hip veins

It is extremely important for the vascular surgeon to know the detailed structure of the circulatory system. If the vessel consists of several trunks, it can be difficult to find a deep femoral vein. Surgeons conditionally divide it into superficial, located deeper, and general, which is closer to the confluence of the deep vein.

The deep vein is the farthest of all major tributaries. It connects to the femoral vessel just below the groin. Further it includes tributaries of a smaller diameter. In addition, two additional ones, called the para-arterial venous bed, flow into the lower part of the mouth of the deep vein.

Common vein

The common femoral vein includes the great saphenous, medial, and lateral veins surrounding the thigh. Each has its own location and meaning. The medial is closer to the lateral. It joins in the large subcutaneous region and above.

The thigh vein usually contains up to 5 valves that prevent blood from flowing in the opposite direction. The distance between them often reaches 7 cm. In this case, the gap is often no more than 12 mm. Sometimes she has two trunks, which are connected at the bottom of the ischial tuberosity. The deep femoral vein is located on the outer part of the femur, which is crossed by its proximal section, flowing into the main one.

The veins accompanying the femoral artery are located in the lower and middle part of the thigh, on the outside or inside of the artery, and connect to it in several places. Such areas are called anastomoses. Depending on how the valves are located in the vessels accompanying the femoral artery, blood can flow in them in different directions.

The large saphenous vein has two or more trunks. True doubling is the case when it enters the femoral with different orifices. But more often they join at the top of the thigh. We have examined the anatomy of the femoral vein.

Pathology

The most common ailments of the thigh veins are thrombosis and venous dilatation. And if the latter disease is widespread and does not threaten life in most cases, although it is rather unpleasant, then thrombosis is another matter. It is worth talking about separately.

Thrombosis

Femoral vein thrombosis is of two types: superficial and deep. Deep vein disease is the formation of blood clots that partially or completely block a vessel. Most often this happens in the lower limbs. More precisely, in the veins of the thigh. This disease affects 20% of the population of our country. In the bulk, the disease occurs in men, quite rarely in women (to a greater extent suffering from varicose veins). Without proper treatment, deep vein thrombosis can be fatal as a result of pulmonary embolism.

Signs of superficial femoral vein thrombosis are:

1. Swelling and pain in the legs, starting in the groin and below.
2. Cyanosis of the skin on the legs.
3. A so-called petechial rash with small red dots.
4. An increase in body temperature as a result of phlebitis - inflammation of the vessel walls.

With deep vein thrombosis, there are two stages: white and blue phlegmas. At the initial stage, due to impaired blood circulation, the skin of the leg becomes pale, cold to the touch, with severe pain syndrome.

Blue phlegmas is a sign of overcrowding of the venous vessels with blood. With it, the skin may darken, and swellings appear on its surface, which contain hemorrhagic fluid. With such symptoms, thrombosis runs the risk of spilling over into acute gangrene.

Preconditions of deep vein thrombosis

Most often, deep vein thrombosis occurs when a vessel is compressed over time by a tumor or bone fragment during a fracture. Another reason for the formation of a plug is impaired blood circulation in certain diseases. Poorly circulating blood leads to stagnation and, accordingly, blood clots. The key causes of clogged veins are:

1. A drop in the rate of blood circulation in the vessels.
2. Increased blood clotting time.
3. Damage to the walls of blood vessels.
4. Prolonged immobility, for example with a serious illness.

Certain professional activities have a negative effect on the condition of the veins. Sellers, cashiers, pilots, international drivers have a hard time. They are forced to stand or sit in one position for a long time. Therefore, they are at risk. Frequently recurring illnesses that lead to dehydration, such as acute intestinal infections with diarrhea and vomiting, chronic bowel and pancreatic diseases. It also occurs against the background of excessive intake of drugs with a diuretic effect. Dangerous pathologies that cause an imbalance of fats and proteins, including diabetes mellitus, atherosclerosis, cancer. Bad habits, such as smoking, alcohol abuse, increase the likelihood of platelets sticking together.

What is femoral vein catheterization for? More on this below.

Diagnostics and treatment

Needless to say, the importance of timely diagnosis and medication or other intervention in DVT is not worth mentioning. To make an accurate diagnosis, it is necessary to do ultrasound or Doppler ultrasonography of the femoral vein. Such diagnostics will help determine the exact location of the thrombus and the degree of its fixation to the vessel wall. In other words, to understand whether it can break off and clog the vessel, as well as cause pulmonary embolism or not. Also, when DVT is detected, the phlebography method is used - X-ray with a contrast agent. However, the most accurate method today is angiography. On the eve of the procedure, you must observe strict bed rest. Femoral vein puncture is sometimes done.

Treatment for DVT depends on the cause of the disease and the individual patient. If the vessel is not completely blocked and the thrombus is unlikely to separate, then conservative therapy is indicated. It is necessary to restore the patency of the veins, prevent the violation of the integrity of the thrombus and avoid vascular embolism. To achieve the above goals, special medications, ointments, and compression therapy are used, for example, it is recommended to wear special compression stockings.

If the patient is in a satisfactory condition, but drug treatment is contraindicated for him, then surgical methods of treating deep thrombosis are used. The operation is carried out on the latest equipment and is high-tech. Thrombectomy is prescribed when the risk of a thrombus rupture and blockage of the main vessels is not excluded. This plug is removed through a small incision by inserting a special catheter. During the operation, the clogged vessel is completely cleared, but a relapse is not excluded.

To avoid thrombosis, you need to adhere to some rules and completely rethink your lifestyle. It is recommended to give up bad habits, eat right, lead a physically active lifestyle, try to avoid injuries to the lower extremities, etc. We examined the femoral arteries and veins. Now you know how they differ and what they are.

Table of contents of the subject "System of the inferior vena cava.":

Just like on the upper limb, veins of the lower extremity are divided into deep and superficial, or subcutaneous,which pass independently of the arteries.

Deep veins of the foot and shins are double and accompany the arteries of the same name. V. poplitea, which is composed of all the deep veins of the leg, is a single trunk located in the popliteal fossa posteriorly and somewhat laterally from the artery of the same name. V. femoralis single, at first it is located laterally from the artery of the same name, then gradually passes to the posterior surface of the artery, and even higher - to its medial surface and in this position passes under the inguinal ligament in lacuna vasorum... Tributaries v. femoralis all double.

From the saphenous veins of the lower limbthe largest are two trunks: v. saphena magna and v. saphena parva... Vena saphena magna, great saphenous vein of the leg, originates on the dorsal surface of the foot from rete venosum dorsale pedis and arcus venosus dorsalis pedis... Having received several tributaries from the side of the sole, it goes up the medial side of the lower leg and thigh. In the upper third of the thigh, it bends to the anteromedial surface and, lying on the wide fascia, goes to the hiatus saphenus. In this place v. saphena magna flows into the femoral vein, spreading over the lower horn of the crescent edge. Often v. saphena magna can be double, and both of its trunks can be infused separately into the femoral vein. From other subcutaneous tributaries of the femoral vein, mention should be made of v. epigastrica superficialis, v. circumflexa ilium superficialis, vv. pudendae externae accompanying the arteries of the same name. They flow partly directly into the femoral vein, partly into v. saphena magna at its confluence in the hiatus saphenus area. V. saphena parva, small saphenous vein of the leg, begins on the lateral side of the dorsal surface of the foot, bends around the bottom and back of the lateral ankle and rises further along the posterior surface of the leg; first, it goes along the lateral edge of the Achilles tendon, and then up in the middle of the posterior part of the leg, corresponding to the groove between the heads of m. gastrocnemii. Having reached the lower corner of the popliteal fossa, v. saphena parva flows into the popliteal vein. V. saphena parvaconnects with branches v. saphena magna.

Table of contents of the subject "Front region of the thigh. Femoral triangle.":
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Neurovascular formations of the femoral triangle. Femoral vessels. Femoral artery and vein. Topography of the femoral artery. Topography of the femoral vein.

Femoral vessels, a. et v. femoralis (Fig. 4.6), are included in femoral triangle from the vascular lacuna inward from the middle of the inguinal ligament. Further, they are located along the bisector of the femoral triangle to its apex.

Femoral vessels surrounded by a dense fascial sheath, passing into their branches.

Figure: 4.6. Front of the thigh. Femoral triangle... 1 - spina iliasa anterior superior; 2 - m. iliopsoas; 3 - n. femoralis; 4 - m. tensor fasciae latae; 5 - m. sarto-rius; 6, 9 - m. vastus medialis; 7 - m. rectus femoris; 8 - m. adductor magnus; 10 - n. saphenus et a descendens genus; 11 - a femoralis; 12 - v. femoralis; 13 - m. adductor longus; 14 - m. gracilis.

Femoral artery and vein

Femoral artery topography

A. femoralis is a direct continuation of the external iliac artery. Its diameter is 8-12 mm. At the level of the hiatus saphenus, the artery is covered in front by the sickle-shaped edge of the saphenous fissure and lies outward from the vein of the same name. Here, three superficial branches extend from the artery: a. epigastrica superficialis, a. circumflexa ilium superficialis and aa. pudendae externae superficialis et profundus.

Topography of the femoral vein

V. femoralis lies medially from the artery, under the ethmoid fascia, where v flows into it. saphena magna and the veins of the same name of the superficial arteries. Further downward, the vein gradually moves to the posterior surface of the artery. At the apex of the femoral triangle, the vein is hidden behind the artery.

Deep veins of the leg - these are the veins accompanying the arteries (anterior and posterior tibial and peroneal veins), and intramuscular veins, popliteal vein. These veins lie next to the arteries, often paired and have many anastomoses with each other, and many valves that allow blood to flow in the proximal direction.

The anterior tibial veins are an upward extension of the vein accompanying a. dorsalis pedis. They can go along with a. dorsalis pedis to the upper border of the interosseous membrane, receiving inflows from the muscle veins of the anterior leg and from the perforating veins.

The posterior tibial veins form from the medial and lateral plantar veins below the medial malleolus. They are located near a. tibialis posterior between the superficial and deep leg flexors. The peroneal veins flow into them, and then they connect with the anterior tibial veins in the lower part of the popliteal region and form the popliteal vein. Many influxes are received from the surrounding muscles, especially the soleus muscle, and the perforating veins.

The peroneal veins arise from the posterolateral heel and run behind the inferior tibiofibular junction. They rise from the peroneal artery between m. flexor hallicis longus and m. tibialis posterior. They receive inflows from the surrounding muscles and perforating veins, and flow into the posterior tibial vein 2-3 cm below the origin of the popliteal artery.

The popliteal vein, which appears when the posterior and anterior tibial veins are connected in the lower part of the popliteal region, goes up through the popliteal fossa and crosses the superficially popliteal artery from the medial to the lateral side. It often doubles, especially below the knee joint (Mullarkey 1965). It receives tributaries from the knee plexus and from the surrounding soft tissue, including both heads of the gastrocnemius muscle, and is usually associated with the lesser saphenous vein. The intramuscular veins of the lower leg are important because they make up the muscle pump. The calf muscle is drained by a pair of veins from each head and into the popliteal vein.

The soleus muscle contains a variable number of thin-walled veins called sinuses, which are located along the length of the muscle. In the lower part of the leg, they are drained by short vessels into the posterior tibial vein. The deep flexor muscles are drained by short vessels that drain into the posterior tibial vein and peroneal vein.

Intramuscular veins are compressed and emptied as the muscles contract, allowing blood to flow upward from the lower extremities. The vessels through which they drain into the veins that accompany the arteries contain valves that allow blood to flow in only one direction.

Superficial veins:
They are represented by the great and small saphenous veins, and the veins connecting them. The greater saphenous vein begins in front of the medial ankle, as a continuation of the medial marginal dorsal vein of the foot. 2-3 cm above the medial malleolus, it deviates posteriorly, crossing the medial surface of the tibia. It runs along the medial part of the lower leg, passes behind the medial condyle of the tibia and goes to the thigh. The greater saphenous vein has two main tributaries to the lower leg. The anterior leg vein originates from the distal part of the dorsal venous arch of the foot, runs along the anterior leg 2-3 cm lateral to the anterior edge of the tibia. In various places in the upper part of the lower leg, but usually below the tuberosity of the tibia, it crosses the tibia and flows into the greater saphenous vein.
The posterior vein begins behind the medial malleolus and sometimes connects to the commonly encountered posterior perforating vein on the medial surface of the foot. It continues upward and into the great saphenous vein below the knee. The small saphenous vein begins behind the lateral malleolus, as a continuation of the lateral marginal dorsal venous arch. It goes up along the lateral edge of the Achilles tendon, and halfway (in the middle of the lower leg) - pierces the deep fascia and goes between the heads of the gastrocnemius muscle.
In 3/4 of cases, it flows into the popliteal vein in the popliteal fossa, usually 3 cm above the knee joint gap. Although the joint can be from 4 cm below and 7 cm above the joint gap (Haeger 1962). In half of the cases, it has connecting branches with deep veins of the thigh and a large saphenous vein.

In 1/4 of cases, the small saphenous vein has no connection with the popliteal vein. In 2/3 of the cases it flows into the deep or superficial vessels of the thigh, and in the remaining 1/3 of cases it flows into the deep veins below the popliteal fossa (Moosman and Hartwell 1964). Dodd (1965) wrote off a popliteal vein that drains superficial tissues over the popliteal fossa and adjacent parts of the posterior thigh and lower leg. It pierces the deep fascia in the center of the fossa or in one of its corners (usually in the center or in the lateral angle) and flows into the lesser saphenous vein, popliteal or gastrocnemius veins.

Usually, 2 or 3 communicating veins run from the saphenous vein upward and medially, flowing into the posterior arched vein, with valves allowing blood to flow in only one direction. The inflows of the small saphenous vein drain the posterolateral surface of the leg along the line of fusion of the posterior intermuscular septum with the deep fascia. It flows into the lesser saphenous vein in the upper part of the leg and often has a connection with the anterolateral tributaries of the great saphenous vein, below the fibula neck.
There are usually 7 to 12 valves in the small saphenous vein, allowing blood to flow only in the proximal direction. Their number does not depend on gender or age (Kosinski 1926).
The perforating veins of the lower leg all have valves that allow blood to flow only from the superficial veins to the deep ones. They are usually associated not with the main saphenous veins themselves, but with their tributaries, and can be divided into 4 groups, in accordance with the deep veins with which they are connected. The distinction between direct perforating veins, which are connected to the veins accompanying arteries, and indirect perforating veins, which drain into the intramuscular veins (Le Dentu 1867), is not important for understanding chronic venous insufficiency and treatment with compression sclerotherapy.

The anterior tibial group of perforators connects the anterior tibial vein to the anterior tibial vein. There are from 3 to 10. They pierce the deep fascia in the area of \u200b\u200bm. extensor digitorum longus, others run along the anterior intermuscular septum. Three of them are permanent. The lowest at the level of the ankle joint, the second at the level of the middle part of the lower leg, and are called "mildcrural vein" (Green et al 1958). Still others are at the point where the anterior leg vein crosses the anterior edge of the tibia. For the construction of the diagnosis, the incompetent perforating veins of this area can be divided into upper, middle and lower in accordance with the boundaries of the lower leg.

The posterior tibial perforating veins connect the posterior arched vein with the posterior tibial veins running in the area of \u200b\u200bthe transverse intermuscular septum. They are divided into upper, middle and lower groups. The total number of posterior tibial perforators may be more than 16 (van Limborgh 1961), but usually from 5 to 6. Upper group: 1 or 2 perforate the deep fascia behind the medial edge of the tibia.

The middle group is in the middle third of the lower leg. The veins pierce the deep fascia 1-2 cm behind the medial edge of the tibia. At least one vein always exists in this group. The lower group is in the lower third of the lower leg. Usually 3 or 4 veins are present here. The lower ones pierce the deep fascia 2-3 cm behind the lower edge of the medial ankle. Others pierce the deep fascia 5-6 cm above it. The superior vein is located at the border of the lower and middle third of the lower leg.

On the back of the lower leg there is a muscle group: soleus and gastrocnemius. There can be up to 14 perforators (Sherman 1949), but usually 3, top, middle and bottom. They usually drain into the communicating veins, which in turn connect the greater and lesser saphenous veins, or less often, directly into the lesser saphenous vein. However, they can also flow into the tributaries of the small saphenous vein.
The peroneal group of perforating veins is located on the fusion line of the deep fascia with the posterior intermuscular septum. There are usually 3 or 4 of them, although there can be up to 10 (van Limborgh 1961). Two of them are permanent, one below the fibula neck, the other at the border of the lower and middle third of the lower leg and is called the lateral ankle perforating vein (Dodd and Cockett 1956). Others are highly variable and are located in the upper, middle and lower third of the lower leg. These veins are from the lateral tributaries of the small saphenous vein, which rises along the line along which the veins pierce the deep fascia. They flow into the peroneal vein along the posterior intermuscular septum.

The peculiar structure of the venous vessels and the composition of their walls determines their capacitive properties. Veins differ from arteries in that they are tubes with thin walls and lumens of relatively large diameter. As well as the walls of arteries, the composition of the venous walls includes smooth muscle elements, elastic and collagen fibers, among which there are much more of the latter.

In the venous wall, structures of two categories are distinguished:
- supporting structures, which include reticulin and collagen fibers;
- elastic-contractile structures, which include elastic fibers and smooth muscle cells.

Collagen fibers under normal conditions maintain the normal configuration of the vessel, and if any extreme impact is exerted on the vessel, these fibers preserve it. Collagen vessels do not take part in the formation of tone inside the vessel, and they also do not affect vasomotor reactions, since smooth muscle fibers are responsible for their regulation.

Veins are made up of three layers:
- adventitia - the outer layer;
- copper - middle layer;
- intima - the inner layer.

There are elastic membranes between these layers:
- internal, which is more pronounced;
- external, which is very slightly different.

The middle membrane of the veins is mainly composed of smooth muscle cells, which are located along the perimeter of the vessel in the form of a spiral. The development of the muscle layer depends on the width of the diameter of the venous vessel. The larger the diameter of the vein, the more developed the muscle layer. The number of smooth muscle elements increases from top to bottom. The muscle cells that make up the middle membrane are located in a network of collagen fibers, which are highly crimped in both the longitudinal and transverse directions. These fibers straighten only when there is a strong stretching of the venous wall.

Superficial veins, which are located in the subcutaneous tissue, have a highly developed smooth muscle structure. This explains the fact that superficial veins, unlike deep veins located at the same level and having the same diameter, perfectly resist both hydrostatic and hydrodynamic pressure due to the fact that their walls have elastic resistance. The venous wall has a thickness that is inversely proportional to the size of the muscle layer surrounding the vessel.

The outer layer of the vein, or adventitia, is a dense network of collagen fibers that create a kind of skeleton, as well as a small number of muscle cells that have a longitudinal arrangement. This muscle layer develops with age, it can be most clearly observed in the venous vessels of the lower extremities. The role of additional support is played by venous trunks of a more or less large size, surrounded by a dense fascia.

The structure of the vein wall is determined by its mechanical properties: in the radial direction the venous wall has a high degree of extensibility, and in the longitudinal direction it is small. The degree of vascular extensibility depends on two elements of the venous wall - smooth muscle and collagen fibers. The stiffness of the venous walls during their strong dilatation depends on collagen fibers, which prevent the veins from stretching very much only under conditions of a significant increase in pressure inside the vessel. If the changes in intravascular pressure are of a physiological nature, then smooth muscle elements are responsible for the elasticity of the venous walls.

Venous valves

Venous vessels have an important feature - they have valves that allow a centripetal blood flow in one direction. The number of valves, as well as their location, serve to provide blood flow to the heart. On the lower limb, the largest number of valves are located in the distal regions, namely, slightly below the place where the mouth of a large tributary is located. In each of the superficial vein highways, the valves are located at a distance of 8-10 cm from each other. The communicating veins, with the exception of the valveless foot perforators, also have a valve apparatus. Often, perforators can enter deep veins in multiple candelabra-like cannulas in appearance, preventing retrograde blood flow with the valves.

The valves of the veins usually have a bicuspid structure, and how they are distributed in a particular segment of the vessel depends on the degree of functional load.
The skeleton for the base of the cusps of the venous valves, which are composed of connective tissue, is a spur of the inner elastic membrane. The cusp of the valve has two surfaces covered with endothelium: one on the sinus side, the other on the lumen side. Smooth muscle fibers located at the base of the valves, directed along the axis of the vein, as a result of changing their direction to the transverse, create a circular sphincter that prolapses into the sinus of the valve in the form of a kind of attachment rim. The stroma of the valve is formed by smooth muscle fibers, which in bundles in the form of a fan go to the valve leaflets. With the help of an electron microscope, you can find elongated thickenings - nodules that are located on the free edge of the valves of the valves of large veins. According to scientists, these are peculiar receptors that record the moment when the valves close. The cusps of an intact valve are longer than the diameter of the vessel; therefore, if they are closed, longitudinal folds are observed on them. Excessive valve leaflet length, in particular, is due to physiological prolapse.

The venous valve is a structure that is strong enough to withstand pressures up to 300 mm Hg. Art. However, part of the blood is discharged into the sinuses of the valves of large veins through thin tributaries that do not have valves that flow into them, due to which the pressure above the valve cusps decreases. In addition, the retrograde blood wave is scattered about the rim of the attachment, which leads to a decrease in its kinetic energy.

With the help of fibrofleboscopy performed during life, one can imagine how the venous valve works. After the retrograde blood wave enters the sinuses of the valve, its cusps move and close. The nodules transmit a signal that they have touched the muscle sphincter. The sphincter begins to expand until it reaches the diameter at which the valve flaps open again and reliably block the path of the retrograde blood wave. When the pressure in the sinus rises above the threshold level, the opening of the mouth of the draining veins occurs, which leads to a decrease in venous hypertension to a safe level.

Anatomical structure of the venous basin of the lower extremities

The veins of the lower extremities are divided not superficial and deep.

The superficial veins include the cutaneous veins of the foot located on the plantar and dorsal surfaces, large, small saphenous veins and their numerous tributaries.

The saphenous veins in the foot area form two networks: the cutaneous plantar venous network and the dorsal cutaneous venous network. Common dorsal digital veins, which enter the cutaneous venous network of the dorsum of the foot, as a result of the fact that they anastomose with each other, the cutaneous dorsal arch of the foot is formed. The ends of the arc continue in the proximal direction and form two trunks running in the longitudinal direction - the medial marginal vein (v. Marginalis medialis) and the marginal lateral vein (v. Marginalis lateralis). On the lower leg, these veins continue in the form of a large and small saphenous veins, respectively. On the plantar surface of the foot, the subcutaneous venous plantar arch stands out, which, widely anastomosed with the marginal veins, sends the intercapital veins to each of the interdigital spaces. The intercapital veins, in turn, anastomose with those veins that form the dorsal arch.

The continuation of the medial marginal vein (v. Marginalis medialis) is the great saphenous vein of the lower extremity (v. Saphena magna), which along the front edge of the inner side of the ankle passes to the lower leg, and then, passing along the medial edge of the tibia, bends around the medial condyle, goes to the inner thigh from the back of the knee joint. In the lower leg area, the GSV is located near the saphenous nerve, with the help of which the innervation of the skin on the foot and lower leg occurs. This feature of the anatomical structure should be taken into account during phlebectomy, since due to damage to the saphenous nerve, long-term and sometimes life-long disturbances of the innervation of the skin in the lower leg area can appear, as well as lead to paresthesias and causalgias.

In the thigh area, the great saphenous vein can have from one to three trunks. In the area of \u200b\u200bthe oval-shaped fossa (hiatus saphenus) is the mouth of the GSV (saphenofemoral anastomosis). At this point, its terminal section makes a bend through the seropid process of the broad fascia of the thigh and, as a result of perforation of the ethmoid plate (lamina cribrosa), flows into the femoral vein. The location of the saphenofemoral anastomosis can be located 2-6 m below the place where the pupar ligament is located.

Many tributaries join the great saphenous vein along its entire length, which carry blood not only from the lower extremities, from the external genital organs, from the anterior abdominal wall, but also from the skin and subcutaneous tissue located in the gluteal region. In a normal state, the large saphenous vein has a lumen width of 0.3 - 0.5 cm and has from five to ten pairs of valves.

Permanent venous trunks that flow into the terminal section of the great saphenous vein:

• v. pudenda externa - external genital, or shame, vein. The occurrence of reflux in this vein can lead to perineal varicose veins;
• v. epigastrica superfacialis - superficial epigastric vein. This vein is the most constant inflow. During surgical intervention, this vessel serves as an important landmark by which it is possible to determine the immediate proximity of the saphenofemoral junction;
• v. circumflexa ilei superfacialis - superficial vein. This vein is located around the ilium;
• v. saphena accessoria medialis - posterior medial vein. This vein is also called the accessory medial saphenous vein;
• v. saphena accessoria lateralis - anterolateral vein. This vein is also called the accessory lateral saphenous vein.

The external marginal vein of the foot (v. Marginalis lateralis) continues with a small saphenous vein (v. Saphena parva). It runs along the back of the lateral ankle, and then goes up: first along the outer edge of the Achilles tendon, and then along its posterior surface, located next to the midline of the posterior surface of the lower leg. From this point on, the small saphenous vein can have one trunk, sometimes two. Near the small saphenous vein is the medial cutaneous nerve of the calf (n. Cutaneus surae medialis), due to which the skin of the posteromedial surface of the leg is innervated. This explains the fact that the use of traumatic phlebectomy in this area is fraught with neurological disorders.

The small saphenous vein, passing through the junction of the middle and upper thirds of the lower leg, penetrates into the deep fascia, located between its leaves. Reaching the popliteal fossa, the SSV passes through the deep leaf of the fascia and most often connects to the popliteal vein. However, in some cases, the small saphenous vein passes over the popliteal fossa and connects either with the femoral vein or with tributaries of the deep vein of the thigh. In rare cases, the SSV flows into one of the tributaries of the great saphenous vein. In the area of \u200b\u200bthe upper third of the leg between the lesser saphenous vein and the system of the greater saphenous vein, many anastomoses are formed.

The largest permanent near-mouth inflow of the small saphenous vein, which has an epifascial location, is the femoral-popliteal vein (v. Femoropoplitea), or Giacomini's vein. This vein connects the SSV with a large saphenous vein located in the thigh. If reflux occurs through the Giacomini vein from the GSV pool, then because of this, varicose expansion of the small saphenous vein may begin. However, the opposite mechanism can also work. If valvular insufficiency of the SSV occurs, then varicose transformation can be observed in the femoral-popliteal vein. In addition, the great saphenous vein will also be involved in this process. This must be taken into account during surgical intervention, since if preserved, the femoral-popliteal vein can be the reason for the return of varicose veins in the patient.

Deep venous system

Deep veins include veins located on the back of the foot and sole, on the lower leg, and in the knee and thigh area.

The deep venous system of the foot is formed by paired companion veins and arteries located near them. The companion veins in two deep arcs bend around the back and plantar region of the foot. The dorsal deep arch is responsible for the formation of the anterior tibial veins - vv. tibiales anteriores, the plantar deep arch is responsible for the formation of the posterior tibial (vv. tibiales posteriores) and receiving peroneal (vv. peroneae) veins. That is, the dorsal veins of the foot form the anterior tibial veins, and the posterior tibial veins are formed from the plantar medial and lateral veins of the foot.

On the lower leg, the venous system consists of three pairs of deep veins - the anterior and posterior tibial veins and the peroneal vein. The main load on the outflow of blood from the periphery is assigned to the posterior tibial veins, into which, in turn, the peroneal veins are drained.

As a result of the fusion of the deep veins of the leg, a short trunk of the popliteal vein (v. Poplitea) is formed. The knee vein hosts the small saphenous vein, as well as the paired veins of the knee joint. After the knee vein enters this vessel through the lower opening of the femoral-popliteal canal, it begins to be called the femoral vein.

The sural vein system consists of paired calf muscles (vv. Gastrocnemius), draining the sinus of the gastrocnemius muscle into the popliteal vein, and the unpaired soleus muscle (v. Soleus), which is responsible for drainage into the popliteal vein of the soleus sinus.

At the level of the joint space, the medial and lateral gastrocnemius vein flows into the popliteal vein by the common mouth or separately, leaving the heads of the gastrocnemius muscle (m. Gastrocnemius).

Near the soleus muscle (v. Soleus) the artery of the same name constantly passes, which in turn is a branch of the popliteal artery (a. Poplitea). The flounder vein independently flows into the popliteal vein, or is proximal to the place where the mouth of the calf veins is located, or flows into it.
The femoral vein (v. Femoralis) is divided into two parts by most specialists: the superficial femoral vein (v. Femoralis superfacialis) is located farther from the confluence of the deep vein of the thigh, the common femoral vein (v. Femoralis communis) is located closer to the place where it the deep vein of the thigh flows into. This unit is important both anatomically and functionally.

The most distally located large tributary of the femoral vein is the deep vein of the thigh (v. Femoralis profunda), which flows into the femoral vein about 6-8 cm below the place where the inguinal ligament is located. Slightly below is the place where small diameter tributaries enter the femoral vein. These tributaries correspond to small branches of the femoral artery. If the lateral vein, which surrounds the thigh, has not one trunk, but two or three, then at the same place its lower branch of the lateral vein flows into the femoral vein. In addition to the above vessels, in the femoral vein, in the place where the mouth of the deep vein of the thigh is located, there is most often the place of confluence of two companion veins that form the paraarterial venous bed.

In addition to the great saphenous vein, the medial lateral veins that run around the thigh also flow into the common femoral vein. The medial vein is more proximal than the lateral one. The place of its confluence can be located either at the same level with the mouth of the great saphenous vein, or slightly above it.

Perforating veins

Venous vessels with thin walls and different diameters - from a few fractions of a millimeter to 2 mm - are called perforating veins. These veins are often oblique and are 15 cm long. Most perforating veins have valves that direct blood from the superficial veins to the deep veins. Along with the perforating veins, which have valves, there are valveless, or neutral ones. These veins are most often located in the foot. The number of valveless perforators in comparison with valve perforators is 3-10%.

Direct and indirect perforating veins

Direct perforating veins are the vessels that connect the deep and superficial veins to each other. The safenopliteal junction is the most typical example of a straight perforating vein. There are not many direct perforating veins in the human body. They are larger and in most cases are located in the distal regions of the limbs. For example, on the lower leg in the tendon part, the perforating veins of the Kokket are located.

The main task of the indirect perforating veins is to connect the saphenous vein with the muscular vein, which has a direct or indirect communication with the deep vein. The number of indirect perforating veins is quite large. These are most often very small veins, which are mostly located where muscle masses are located.

Both direct and indirect perforating veins often communicate not with the trunk of the saphenous vein itself, but with only one of its tributaries. For example, the perforating veins of the Cockett running along the inner surface of the lower third of the leg, on which the development of varicose and post-thrombophlebic disease is quite often observed, not the trunk of the great saphenous vein itself is connected to the deep veins, but only its posterior branch, the so-called Leonardo's vein. If this feature is not taken into account, then this can lead to a relapse of the disease, despite the fact that during the operation the trunk of the great saphenous vein was removed. There are more than 100 perforators in the human body. In the thigh area, as a rule, there are indirect perforating veins. Most of them are in the lower and middle third of the thigh. These perforators are located transversely, with their help, the large saphenous vein is connected to the femoral vein. The number of perforators is different - from two to four. Normally, blood flows through these perforating veins exclusively into the femoral vein. Large perforating veins are most often found immediately near where the femoral vein enters (Dodd's perforator) and where it exits (Gunther's) from the Gunter's canal. There are cases when, with the help of communicating veins, the great saphenous vein is connected not with the main trunk of the femoral vein, but with the deep vein of the thigh or with a vein that runs next to the main trunk of the femoral vein.