Veins of the Lower Extremity
The veins of the lower extremities may be divided in two main groups: deep and superficial. The superficial veins are found under the skin in the superficial fascia. The deep venous system accompanies the arteries. Valves are present in both systems, but are more numerous in the deep veins.
Superficial Veins of the Lower Limb
The main named superficial veins are the great (long, magna) and small (lesser, parva) saphenous veins. Most of the tributaries to this system are unnamed (Figs. 23.1, 23.2).
Great (Long, Magna, Internal) Saphenous Vein
The great saphenous vein is the longest vein in the human body. This vein begins in the medial marginal vein of the foot and ends joining, through the saphenous opening, the femoral vein below the inguinal ligament. The saphena magna is often duplicated below the knee (Fig. 23.3), and it is often connected to the small saphenous vein through a long superficial vein called Giacomini vein (Fig. 23.1). The great saphenous vein ascends anterior to the tibial malleolus and crosses the distal third of the medial surface of the tibia oblique to its medial border; from there it ascends behind the border of the knee and then to the medial aspect of the thigh, and finally joins the femoral vein through the saphenous opening.
Tributaries
At the ankle—medial marginal vein
In the leg—free communications with the small saphenous vein and deep veins, perforating veins, frontal vein, tibial malleolus vein, and from the calf
In the thigh—from the medial and posterior aspect; may form the accessory saphenous vein
Tributaries
Superficial epigastric
Superficial circumflex iliac
Superficial external pudendal vein
Thoraco epigastric vein
Small (Short, Parva, External, Lesser) Saphenous Vein
This vein is a continuation of the lateral marginal vein of the foot, at the back of the leg, ending in the popliteal vein. It receives numerous cutaneous tributaries and communicates with the great saphenous vein (Fig. 23.4).
Perforating Veins
The great and lesser saphenous veins are connected with the deep veins through the perforating veins. The perforating veins have valves arranged so that normally they prevent the flow of blood from the deep to the superficial veins.
The perforating veins are found in the foot, leg, and thigh.
In the Foot
There are four perforating veins.
One 2.5 cm below the medial malleolus
One 3.5 cm below and anterior to the medial malleolus
Two 3.0 cm below and anterior to the lateral malleolus
In the Leg
There are 16 constant perforating veins.
8 drain into the posterior tibial veins (Cockett and Boyd veins)
4 drain into the peroneal veins
4 drain into the soleal and gemelar veins
In the Thigh
There are two constant perforating veins (Dodd group or perforating veins of Hunter)
Deep Veins of the Lower Limb
These veins are companions of the arteries and their branches.
