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Phlebologie 2018; 47(06): 352-362
DOI: 10.1055/s-0038-1675460
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Georg Thieme Verlag KG Stuttgart · New York

Anatomy of the superficial venous system of the leg

Article in several languages: deutsch | English
E. Brenner
1   Sektion für klinisch-funktionelle Anatomie, Medizinische Universität Innsbruck, Österreich
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Publication History

Eingegangen: 03 September 2018

Angenommen: 26 September 2018

Publication Date:
25 January 2019 (online)

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Summary

The superficial venous system of the leg starts with the epifascial veins, i.e. the various subcutaneous venous networks, the accessory saphenous veins, superficial epigastric vein, the superficial iliac circumflex vein, and the external pudendal veins. These flow into the two intrafascial veins, the great and the small saphenous veins. These, in turn, enter the deep venous system, the great saphenous vein constant in the saphenous hiatus, the small saphenous vein in just over two thirds of cases in the popliteal fossa. In addition, numerous connections exist between the superficial and the deep venous system by the perforating veins. The superficial veins communicate with each other by communicating veins. In the superficial veins numerous parietal valves are found, mostly with two, in smaller and smallest veins also with only one valve leaflet. At the entrance of the great saphenous vein into the femoral vein, there may also be an ostial valve. The wall of the superficial veins has the typical three-layered structure with a tunica intima, a tunica media and a tunica externa. The tunica intima comprises, at least in the great saphenous vein, an internal elastic membrane. In the tunica media, longitudinally arranged bundles of smooth musculature are found inside, followed by dense bundles of circularly arranged smooth musculature. In the tunica externa longitudinal muscle fiber bundles can also be found. Both the great and the small saphenous vein lie in their own fascial sheath, the floor of which is formed by the crural fascia or the fascia lata and their superficial leaf by the respective saphenous fascia. Within these „saphenous compartments” the respective veins are laterally anchored by saphenous ligaments. About 60 large-volume, clinically significant perforating veins connect the superficial with the deep venous system. At least one flap in each perforating vein prevents backflow from the deep venous system.

Keywords

Great saphenous vein - small saphenous vein - accessory saphenous veins - superficial circumflex iliac vein - superficial epigastric vein - external pudendal vein - perforating veins
 

  • Literatur

  • 1 Aellig WH. Clinical pharmacology, physiology and pathophysiology of superficial veins--1. Br J Clin Pharmacol 1994; 38 (03) 181-196.
    CrossrefPubMedGoogle Scholar
  • 2 Aellig WH. Clinical pharmacology, physiology and pathophysiology of superficial veins--2. Br J Clin Pharmacol 1994; 38 (04) 289-305.
    CrossrefPubMedGoogle Scholar
  • 3 Aharinejad S, Nedwed S, Michlits W, Dunn R, Abraham D, Vernadakis A, Marks Jr SC. Valvular density alone cannot account for sites of chronic venous insufficiency and ulceration in the lower extremity. Microcirculation 2001; 08 (05) 347-354.
    CrossrefGoogle Scholar
  • 4 Altenkämper H, Eldenburg M. Farbatlas der Phlebologie. 1st ed. Hannover: Schlüter; 1993
    Google Scholar
  • 5 Attardi G. Demonstration in vivo and in vitro of Peristaltic Contractions in the Portal Vein of Adult Mammals (Rodents). Nature 1955; 176 (4471): 76-77.
    CrossrefPubMedGoogle Scholar
  • 6 Attardi G, Attardi-Gandini D. Spontaneous peristaltic activity of veins of chick embryos and newly hatched chickens explanted in vitro. Experientia 1955; 11 (01) 37-38.
    CrossrefPubMedGoogle Scholar
  • 7 Bommas-Ebert U, Teubner P, Voß R. Kurzlehrbuch Anatomie: und Embryologie. 3rd ed. Stuttgart, New York: Thieme; 2011
    Google Scholar
  • 8 Brenner E. Spezielle Anatomie der Crossenregionen. In: Noppeney T, Nüllen H. (Hrsg.) Varikose: Diagnostik – Therapie – Begutachtung. Berlin, Heidelberg: Springer; 2010: 18-24.
    Google Scholar
  • 9 Butterworth DM, Rose SS, Clark P, Rowland P, Knight S, Haboubi NY. Light-Microscopy, Immunohistochemistry and Electron-Microscopy of the Valves of the Lower-Limb Veins and Jugular Veins. Phlebology 1992; 07 (01) 27-30.
    CrossrefGoogle Scholar
  • 10 Caggiati A. Fascial relationships of the long saphenous vein. Circulation 1999; 100 (25) 2547-2549.
    CrossrefPubMedGoogle Scholar
  • 11 Caggiati A. Fascial relations and structure of the tributaries of the saphenous veins. Surg Radiol Anat 2000; 22 (3–4): 191-196.
    CrossrefPubMedGoogle Scholar
  • 12 Caggiati A. Fascial relationships of the short saphenous vein. J Vasc Surg 2001; 34 (02) 241-246.
    CrossrefPubMedGoogle Scholar
  • 13 Caggiati A. The nomenclature of the veins of the lower limbs, based on their planar anatomy and fascial relationships. Acta Chir Belg 2004; 104 (03) 272-275.
    CrossrefPubMedGoogle Scholar
  • 14 Caggiati A. The venous valves of the lower limbs. Phlebolymphology 2013; 20 (02) 87-95.
    Google Scholar
  • 15 Caggiati A, Bergan JJ, Gloviczki P, Eklof B, Allegra C, Partsch H. International Interdisciplinary Consensus Committee on Venous Anatomical T. Nomenclature of the veins of the lower limb: extensions, refinements, and clinical application. J Vasc Surg 2005; 41 (04) 719-724.
    CrossrefPubMedGoogle Scholar
  • 16 Caggiati A, Bergan JJ, Gloviczki P, Jantet G, Wendell-Smith CP, Partsch H. International Interdisciplinary Consensus Committee on Venous Anatomical Terminology. Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement. J Vasc Surg 2002; 36 (02) 416-422.
    CrossrefPubMedGoogle Scholar
  • 17 Caggiati A, Phillips M, Lametschwandtner A, Allegra C. Valves in small veins and venules. Eur J Vasc Endovasc Surg 2006; 32 (04) 447-452.
    CrossrefPubMedGoogle Scholar
  • 18 Corley GJ, Broderick BJ, Nestor SM, Breen PP, Grace PA, Quondamatteo F, Olaighin G. The anatomy and physiology of the venous foot pump. Anat Rec (Hoboken) 2010; 293 (03) 370-378.
    CrossrefPubMedGoogle Scholar
  • 19 Crotty TP. The venous valve agger and plasma noradrenaline-mediated venodilator feedback. Phlebology 2007; 22 (03) 116-130.
    CrossrefPubMedGoogle Scholar
  • 20 Elsharawy MA, Naim MM, Abdelmaguid EM, Al-Mulhim AA. Role of saphenous vein wall in the pathogenesis of primary varicose veins. Interact Cardiovasc Thorac Surg 2007; 06 (02) 219-224.
    CrossrefGoogle Scholar
  • 21 Fischer H. Der lichtmikroskopische Bau der Venenwand mit besonderer Berucksichtigung der Einwirkung des hydrostatischen Druckes. Zentralbl Phlebol 1967; 06 (02) 209-220.
    Google Scholar
  • 22 Franklin KJ. Valves in Veins: An Historical Survey. Proc R Soc Med 1927; 21 (01) 1-33.
    CrossrefPubMedGoogle Scholar
  • 23 Freerksen E. Die Venen des menschlichen Handrückens. Z Anat Entw Gesch 1937; 108 (01) 82-111.
    CrossrefGoogle Scholar
  • 24 Hach W, Gruß JD, Hach-Wunderle V, Jünger M. VenenChirurgie. Stuttgart, New York: Schattauer; 2006
    Google Scholar
  • 25 Hach W, Hach-Wunderle V. Die retrograde und die antegrade Strömungsinsuffizienz der tiefen Beinvenen als Grundlage für chirurgische Überlegungen. Gefässchirurgie 1998; 03 (02) 110-116.
    Google Scholar
  • 26 Hamann JJ, Valic Z, Buckwalter JB, Clifford PS. Muscle pump does not enhance blood flow in exercising skeletal muscle. J Appl Physiol (1985) 2003; 94 (01) 6-10.
    CrossrefPubMedGoogle Scholar
  • 27 Hammersen F, Fischer H, Bräuer H. Blutfluß, Venen und Oedeme: zur Pathophysiologie des Niederdrucksystems. München: Müller & Steinicke; 1985
    Google Scholar
  • 28 Hochauf S, Sternitzky R, Schellong SM. Struktur und Funktion des venösen Systems. Herz 2007; 32 (01) 3-9.
    CrossrefPubMedGoogle Scholar
  • 29 Kubik S, May R. Das Verspannungssystem der Venen in der Subinguinalregion. Aktuelle Probleme Angiologie 1979; 38: 51-65.
    Google Scholar
  • 30 Leonhardt H, Tillmann B, Zilles K. (Hrsg.) Topographie der Organsysteme, Systematik der peripheren Leitungsbahnen. 4. Stuttgart, New York: Thieme; 1988
    Google Scholar
  • 31 Ludbrook J. Valvular Defect in Primary Varicose Veins: Cause or Effect?. Lancet 1963; 02 (7321): 1289-1292.
    Google Scholar
  • 32 May R. Chirurgie der Bein- und Beckenvenen. Stutgart: Thieme; 1974
    Google Scholar
  • 33 Mühlberger D, Morandini L, Brenner E. An anatomical study of femoral vein valves near the saphenofemoral junction. J Vasc Surg 2008; 48 (04) 994-999.
    CrossrefPubMedGoogle Scholar
  • 34 Mühlberger D, Morandini L, Brenner E. Venous valves and major superficial tributary veins near the saphenofemoral junction. J Vasc Surg 2009; 49 (06) 1562-1569.
    CrossrefPubMedGoogle Scholar
  • 35 Myers KA, Ziegenbein RW, Zeng GH, Matthews PG. Duplex ultrasonography scanning for chronic venous disease: patterns of venous reflux. J Vasc Surg 1995; 21 (04) 605-612.
    CrossrefPubMedGoogle Scholar
  • 36 Noppeney T, Nüllen H. (Hrsg.) Varikose. Diagnostik – Therapie – Begutachtung. Berlin, Heidelberg: Springer; 2010
    Google Scholar
  • 37 Pierer JF, Choulant L. (Hrsg.) Medizinisches Realwörterbuch zum Handgebrauch practischer Aerzte und Wundärzte und zu belehrender Nachweisung für gebildete Personen aller Stände. Erste Abtheilung: Anatomie und Physiologie. Siebenter Band. Rh-Syz. Altenburg: Literatur=Comptoir; 1827
    CrossrefGoogle Scholar
  • 38 Rieger H, Strauss AL, Schoop W. Klinische Angiologie. Berlin: Springer; 1998
    Google Scholar
  • 39 Riml O. Über das Verhalten des Blutdruckes in der Vena cava bei plötzlichem Zirkulationsstillstande. Naunyn-Schmiedeberg’s Archives of Pharmacology 1929; 139 (03) 231-239.
    Google Scholar
  • 40 Rudofsky G. Epidemiologie und Pathophysiologie der primären Varikosis. Langenbecks Arch Chir 1988; (Suppl. 02) 139-144.
    PubMedGoogle Scholar
  • 41 Salter SJH. Vein. In: Todd RB. (Hrsg.) Cyclopaedia of anatomy and physiology. London: Longman, Brown, Green, Longmans, & Roberts; 1849–1852 1367-1403.
    Google Scholar
  • 42 Sappey PC. Traité d’anatomie. Paris: 1869
    Google Scholar
  • 43 Schweighofer G, Mühlberger D, Brenner E. The anatomy of the small saphenous vein: fascial and neural relations, saphenofemoral junction, and valves. J Vasc Surg 2010; 51 (04) 982-989.
    CrossrefPubMedGoogle Scholar
  • 44 Scultetus AH, Villavicencio JL, Rich NM. Facts and fiction surrounding the discovery of the venous valves. J Vasc Surg 2001; 33 (02) 435-441.
    CrossrefPubMedGoogle Scholar
  • 45 Shepherd JT, Rusch NJ, Vanhoutte PM. Effect of cold on the blood vessel wall. Gen Pharmacol 1983; 14 (01) 61-64.
    CrossrefPubMedGoogle Scholar
  • 46 Strauß A. Klappenschlussfrequenzen der oberen und unteren Extremität (am Beispiel der terminalen Klappe der V. saphena magna und der terminalen Klappe der V. cephalica) im direkten Vergleich und im Zusammenhang mit anderen Messgrößen. Thesis: Sektion für klinisch-funktionelle Anatomie, Dept. für Anatomie, Histologie und Embryologie. Innsbruck: Medizinische Universität Innsbruck; 2010
    CrossrefGoogle Scholar
  • 47 Strauß A, Glodny B, Brenner E. Klappenschlussfrequenzen der oberen und unteren Extremität im direkten Vergleich und im Zusammenhang mit anderen Messgrößen – Am Beispiel der terminalen Klappe der Vena saphena magna und der terminalen Klappe der Vena cephalica. VasoMed 2010; 22 (05) 127-128.
    Google Scholar
  • 48 Ströbel P. Anatomie des epifaszialen Venensystems. In: Noppeney T, Nüllen H. (Hrsg.) Varikose. Diagnostik – Therapie – Begutachtung. Berlin, Heidelberg: Springer; 2010: 10-18.
    Google Scholar
  • 49 Tasch C, Brenner E. The ostial valve of the great saphenous vein. Phlebology 2012; 27 (04) 179-183.
    CrossrefPubMedGoogle Scholar
  • 50 Tessari L, Capelli M. The study of the sapheno-femoral junction to understand the distribution of refluxes in chronic venous disease. Medicographia 2008; 30 (02) 112-115.
    Google Scholar
  • 51 Tsantilas P. Aufbau der Venenwand der gesunden V. saphena magna. Thesis: Sektion für klinischfunktionelle Anatomie. Innsbruck: Medizinische Universität Innsbruck; 2012: 64.
    Google Scholar
  • 52 Wagner AH. Physiologie und Pathophysiologie der venösen Hämodynamik. In: Noppeney T, Nüllen H. (Hrsg.) Varikose. Diagnostik – Therapie – Begutachtung. Berlin, Heidelberg: Springer; 2010: 51-60.
    Google Scholar
  • 53 Zwillenberg LO, Laszt L, Zwillenberg H. Die Feinstruktur der Venenwand bei Varikose. Angiologica 1971; 08 (06) 318-346.
    Google Scholar