Venous Drainage of Upper Limb and Lower Limb

Veins are divided into two groups: superficial veins and Deep veins. Superficial veins drain into deep veins. Superficial veins are found subcutaneously, whereas Deeper veins are found in the fascial compartment, running along with the muscle. Veins have the same name as arteries.

Venous drainage of Upper Limb

Cephalic Vein

The Dorsal venous arch on the dorsal side of the hand drains into superficial veins. The superficial vein in the roof of the anatomical snuff box is the cephalic vein. The cephalic vein runs on the lateral side of the radius bone and Drains mainly into the axillary vein in the axilla. It drains partly into the basilic vein as well. The cephalic vein in the axilla pierces the clavipectoral fascia and drains into the axillary vein.

Basilic Vein

Medially, the dorsal venous arch continues to the Basilic vein. The superficial vein in the base of the forearm is a basilic vein. The basilic vein drains into the brachial vein and then into the axillary vein. The basilic vein receives venous blood from another superficial vein, i.e., the median cubital vein.

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Median Cubital Vein

Communication between the cephalic vein and basilic vein is the median cubital vein. It runs lateral to the medial, which is venous flow of blood. Median cubital vein is quite a convenient vein for blood transfusion and taking blood samples.

Axillary Vein

The basilic vein drains into the axillary vein. The axillary vein is the continuation of the brachial vein. The brachial vein is the continuation of the radial vein and the ulnar vein. The cephallic vein enters the Axillary vein after piercing the Clavipectoral fascia, and the Axillary vein continues as the subclavian vein in the neck region.

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Venous Drainage of Lower Limbs

3 groups of veins:

• Superficial group: Ex: Great saphenous vein and Short saphenous vein 
• Deeper veins: Examples include the popliteal vein, Fibular vein, and Tibial vein
• Perforator veins: These veins connect veins that drain the blood from the superficial veins into the deeper veins. They have to perforate the deep fascia to drain into the deeper vein. Deeper veins receive blood from the superficial veins. Perforator veins are present, preventing the flow of blood from deep to superficial veins.

The Dorsal venous arch is present in the dorsal foot, and it gives a great saphenous vein. The great saphenous vein runs anteriorly to the medial malleolus (site for venous suction and IV fluids administration in burns). The popliteal vein is formed by the union of tibial veins (deeper veins). It drains the short saphenous vein, which is a superficial vein given by the dorsal venous arch.

• Superficial veins: Great saphenous vein and short saphenous vein.
• Deeper veins: Tibial veins, popliteal vein, and femoral vein
• Perforators:
  • Supra-ankle cocketts perforator
  • Boyd’s perforator
  • Dodd’s perforator
  • Hunter’s perforator

Deeper veins

The deep plantar venous arch in the sole will drain the venous blood into the medial plantar vein and lateral plantar vein. 

They will follow the medial and lateral plantar artery to join into the posterior tibial vein. The posterior tibial artery is sandwiched between the two posterior tibial veins. They are known as venae commitantes.

Heat exchange can occur between the artery and vein as they are running against gravity. The pulsations of the artery can be utilized by the vein to move the blood upwards.

This will then be joined by the fibular vein, which drains the lateral aspect of the leg region, and will drain the blood along with the posterior tibial vein into the popliteal vein. The anterior tibial vein has to drain into the popliteal vein.

The popliteal vein passes through the adductor hiatus and continues as the femoral vein in the adductor canal, and it will enter the femoral triangle. Bedridden patients may develop pulmonary embolism. So, they are advised to do active–passive movement of the leg and calf muscles.

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Superficial veins

Great Saphenous

The Dorsal venous arch medially drains into the great saphenous vein. The great saphenous vein passes through the opening, known as the fossa ovalis, and drains into the femoral vein.

On the lateral side, it drains into the short saphenous vein, which is formed from the medial marginal vein of the great toe. It passes anterior to the medial malleolus, goes a bit behind and comes to the anterior again while moving up towards the femoral vein.

It enters the cribriform fascia to enter the femoral vein. The saphenofemoral junction lies about 2.5 cm below the inguinal ligament and approximately 4 cm inferolateral to the pubic tubercle on the hip bone. 

There are 20 valves to prevent the retrograde flow of blood.

Trendelenburg operation for the varicose vein:

• Flush ligation is done. To remove the great saphenous vein as close as possible to the femoral vein after it has received all its tributaries.
• External pudendal vein drains the perineum region.
• Great saphenous vein can be used in coronary artery bypass grafts. 

Short Saphenous 

Dorsal venous arch continues on the lateral margin (little toe) and forms a short saphenous vein. It runs lateral to the Achilles tendon. Then, through the calf region and enters the popliteal vein by piercing the deep fascia on the roof of the popliteal fossa. 

Running between the two heads of the gastrocnemius, it drains into the popliteal vein. The popliteal vein continues further as the femoral vein. A total of 13 valves are present to prevent the backflow of blood. Short saphenous veins run along the sural vein, which is a branch of the tibial vein.

Perforators

These are present between the superficial veins and deeper veins. They prevent the flow of blood from deeper veins to superficial veins. Lower limbs have around 200 perforators.

Supra-ankle- Cockett's Perforators

It drains blood from the superficial vein to the deeper vein. A total of 3 perforators are present, which join to form the posterior arch vein. The superficial vein drains the blood into the posterior arch vein. It is then sent through this Cockett’s perforator into the deeper veins, which is the posterior tibial vein coming from the plantar vein.

Other Perforations

• Hunterian perforator: Present in the mid-thigh region. It drains the blood from the great saphenous vein to the femoral vein.
• Dodd's perforator: Present above the knee. It drains the blood from the great saphenous vein to the femoral vein
• Boyd's perforator: Present below the knee. It helps in communicating the superficial great saphenous vein with the deeper popliteal or posterior tibial vein. These perforators have valves to prevent the reversal of blood flow.

Incompetence of the Perforations

In professions where there are long-standing jobs, perforators can become incompetent, causing draining of blood from deeper veins to superficial veins. So, the superficial vein becomes dilated, elongated, and tortuous (DET) and forms varicose veins.

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Frequently asked questions:

Q: What is the Trendelenburg operation test done for?

Answer: Varicose veins 

Q: What is the most common cause of varicose veins?

Answer: Prolonged standing and excessive weight gain are the main causes of varicose veins.

Q: How many valves are there to prevent the retrograde flow of the blood?

Answer: 20 valves

Q: Where are the superficial and deep veins seen in the human body?

Answer:  Superficial veins are found subcutaneous whereas Deeper veins are found in the fascial compartment, running along with the muscle.

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