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 subcutaneous 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. Superficial vein in the roof of the anatomical snuff box is cephalic vein. Cephalic vein runs on the lateral side with radius bone and Drains mainly into the axillary vein in axilla. It drains partly into basilic vein as well. Cephalic vein in the axilla pierces the clavipectoral fascia and drains into the axillary vein.

Basilic Vein

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

Median Cubital Vein

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

Axillary Vein

Basilic vein drains into Axillary vein. Axillary vein is the continuation of Brachial vein. Brachial vein is the continuation of radial vein and ulnar vein. Cephalic vein will enter into the Axillary vein after piercing in the Clavipectoral fascia and the Axillary vein continues as 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 Popliteal vein, Fibular vein and Tibial vein
• Perforator veins: These veins Connect veins drain the blood of 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. Great saphenous vein runs anteriorly to medial malleolus (site for venous suction and iv fluids administration in burns). Popliteal vein is formed by the union of tibial veins (deeper veins). It Drains short saphenous vein which is 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 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 the 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 will drain the blood along with the posterior tibial vein into the popliteal vein. Anterior tibial vein has to drain into the popliteal vein. 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 active – passive movement of the leg and calf muscles.

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Superficial veins

Great Saphenous

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

On the lateral side it will drain into the short saphenous vein which is formed from the medial marginal vein of the great toe. And it passes anterior to medial malleolus, goes a bit behind and comes to the anterior again while moving up towards the femoral vein. And enters the cribriform fascia to enter the femoral vein. Saphenofemoral junction lies about 2.5 cm below the inguinal ligament and approximately 4 cm inferolateral to the pubic tubercle on the hip bone. 

20 valves are there to prevent the retrograde flow of the 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 is draining the perineum region.
• Great saphenous vein can be used in coronary artery bypass grafts. 

Short Saphenous 

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

Running between the two heads of gastrocnemius it drains into the popliteal vein. Popliteal vein continues further as the femoral vein. A total of 13 valves are there to prevent the backflow of the blood. Short saphenous veins run along the sural vein which is  the 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 superficial vein to deeper vein. A total of 3 perforators are present which joins to form the posterior arch vein. Superficial vein drains the blood into - Posterior arch vein. It is then sent through this cockett’s perforator into the deeper veins that is 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 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 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 excessiva 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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