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Semin intervent Radiol 2005; 22(3): 147-156
DOI: 10.1055/s-2005-921948
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Lower Extremity Venous Anatomy

Mark H. Meissner1
  • 1Department of Surgery, University of Washington School of Medicine, Seattle, Washington
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Publication History

Publication Date:
27 October 2005 (online)

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ABSTRACT

The lower extremity venous system includes the superficial, deep, and perforating veins. The antegrade flow of blood within these veins is ensured by a system of muscular venous pumps and bicuspid valves. Dysfunction of the system may result from degeneration of the vein wall, post-thrombotic valvular damage, chronic venous obstruction, or dysfunction of the muscular pumps. Although chronic venous disease often receives less attention than arterial disease, it includes an array of manifestations resulting from a complex interaction of anatomy and hemodynamic failure. A thorough understanding of the highly variable venous anatomy is essential to understanding the underlying pathophysiology as well as in directing treatment.

KEYWORDS

Vein - anatomy - thrombosis - valvular incompetence

REFERENCES

  • 1 Carter C J, Anderson F A, Wheeler H B. Epidemiology and pathophysiology of venous thromboembolism. In: Hull RD, Raskob GE, Pineo GF Venous Thromboembolism: An Evidence-Based Atlas. Armonk, NY; Futura Publishing Company 1996: 3-20
    Search in Google Scholar
  • 2 Nawroth P P, Handley D A, Esmon C T, Stern D M. Interleukin 1 induces endothelial cell procoagulant while suppressing cell-surface anticoagulant activity.  Proc Natl Acad Sci USA. 1986;  83 3460-3464
    PubMedSearch in Google Scholar
  • 3 Stewart G J. Neutrophils and deep venous thrombosis.  Haemostasis. 1993;  23(suppl 1) 127-140
    PubMedSearch in Google Scholar
  • 4 Moneta G L, Nehler M R. The lower extremity venous system: anatomy and physiology of normal venous function and chronic venous insufficiency. In: Gloviczki P, Yao JST Handbook of Venous Disorders: Guidelines of the American Venous Forum. 1st ed. London; Chapman and Hall Medical 1996: 3-26
    Search in Google Scholar
  • 5 Browse N, Burnand K, Thomas M. Diseases of the Veins: Pathology, Diagnosis, and Treatment. London; Edward Arnold 1988
    Search in Google Scholar
  • 6 van Bemmelen P S, Beach K, Bedford G, Strandness D E. The mechanism of venous valve closure.  Arch Surg. 1990;  125 617-619
    PubMedSearch in Google Scholar
  • 7 van Bemmelen P S, Bedford G, Beach K, Strandness D E. Quantitative segmental evaluation of venous valvular reflux with duplex ultrasound scanning.  J Vasc Surg. 1989;  10 425-431
    PubMedSearch in Google Scholar
  • 8 Caggiati A, Bergan J J, Gloviczki P, Jantet G, Wendell-Smith C P, Partsch H. Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement.  J Vasc Surg. 2002;  36 416-422
    CrossrefPubMedSearch in Google Scholar
  • 9 Somjen G M. Anatomy of the superficial venous system.  Dermatol Surg. 1995;  21 35-45
    PubMedSearch in Google Scholar
  • 10 Thomson H. The surgical anatomy of the superficial and perforating veins of the lower limb.  Ann R Coll Surg Engl. 1979;  61 198-205
    PubMedSearch in Google Scholar
  • 11 Mozes G, Gloviczki P, Menawat S S, Fisher D R, Carmichael S W, Kadar A. Surgical anatomy for endoscopic subfascial division of perforating veins.  J Vasc Surg. 1996;  24 800-808
    PubMedSearch in Google Scholar
  • 12 Leu H J, Vogt M, Pfrunder H. Morphological alterations of non-varicose and varicose veins. (A morphological contribution to the discussion on pathogenesis of varicose veins).  Basic Res Cardiol. 1979;  74 435-444
    CrossrefPubMedSearch in Google Scholar
  • 13 Mozes G, Carmichael S W, Gloviczki P. Development and anatomy of the venous system. In: Gloviczki P, Yao JST Handbook of Venous Disorders: Guidelines of the American Venous Forum. 2nd ed. London; Arnold 2001: 11-24
    Search in Google Scholar
  • 14 Cotton L T. Varicose veins: gross anatomy and development.  Br J Surg. 1961;  48 589-597
    CrossrefPubMedSearch in Google Scholar
  • 15 LePage P A, Villavicencio J L, Gomez E R, Sheridan M N, Rich N M. The valvular anatomy of the iliac venous system and its clinical implications.  J Vasc Surg. 1991;  14 678-683
    CrossrefPubMedSearch in Google Scholar
  • 16 Mathews R, Smith P A, Fishman E K, Marshall F F. Anomalies of the inferior vena cava and renal veins: embryologic and surgical considerations.  Urology. 1999;  53 873-880
    CrossrefPubMedSearch in Google Scholar
  • 17 Negus D. The surgical anatomy of the veins of the lower limb. In: Dodd H, Cockett FB The Pathology and Surgery of the Veins of the Lower Limb. 2nd ed. Edinburgh; Churchill Livingstone 1976: 18-49
    Search in Google Scholar
  • 18 Burnand K G. The physiology and hemodynamics of chronic venous insufficiency of the lower limb. In: Gloviczki P, Yao JST Handbook of Venous Disorders: Guidelines of the American Venous Forum. 2nd ed. London; Arnold 2001: 49-57
    Search in Google Scholar
  • 19 Porter J, Moneta G. Reporting standards in venous disease: an update.  J Vasc Surg. 1995;  21 635-645
    CrossrefPubMedSearch in Google Scholar
  • 20 Goldman M P, Fronek A. Anatomy and pathophysiology of varicose veins.  J Dermatol Surg Oncol. 1989;  15 138-145
    PubMedSearch in Google Scholar
  • 21 Ludbrook J. The musculovenous pumps of the human lower limb.  Am Heart J. 1966;  71 635-641
    CrossrefPubMedSearch in Google Scholar
  • 22 Back T L, Padberg Jr F T, Araki C T, Thompson P N, Hobson R W. Limited range of motion is a significant factor in venous ulceration.  J Vasc Surg. 1995;  22 519-523
    PubMedSearch in Google Scholar
  • 23 Nicolaides A N, Hussein M K, Szendro G, Christopoulos D, Vasdekis S, Clarke H. The relationship of venous ulceration with ambulatory venous pressure measurements.  J Vasc Surg. 1993;  17 414-419
    CrossrefPubMedSearch in Google Scholar
  • 24 Nicolaides A N. Investigation of chronic venous insufficiency: a consensus statement (France, March 5-9, 1997).  Circulation. 2000;  102 E126-E163
    CrossrefPubMedSearch in Google Scholar
  • 25 Hosoi Y, Zukowski A, Kakkos S K, Nicolaides A N. Ambulatory venous pressure measurements: new parameters derived from a mathematic hemodynamic model.  J Vasc Surg. 2002;  36 137-142
    CrossrefPubMedSearch in Google Scholar
  • 26 Labropoulos N, Giannoukas A D, Nicolaides A N, Veller M, Leon M, Volteas N. The role of venous reflux and calf muscle pump function in nonthrombotic chronic venous insufficiency: correlation with severity of signs and symptoms.  Arch Surg. 1996;  131 403-406
    PubMedSearch in Google Scholar
  • 27 Cordts P R, Hartono C, LaMorte W W, Menzoian J O. Physiologic similarities between extremities with varicose veins and with chronic venous insufficiency utilizing air plethysmography.  Am J Surg. 1992;  164 260-264
    PubMedSearch in Google Scholar
  • 28 van Bemmelen P S, Mattos M A, Hodgson K J et al.. Does air plethysmography correlate with duplex scanning in patients with chronic venous insufficiency?.  J Vasc Surg. 1993;  18 796-807
    CrossrefPubMedSearch in Google Scholar
  • 29 Araki C T, Back T L, Padberg F T et al.. The significance of calf muscle pump function in venous ulceration.  J Vasc Surg. 1994;  20 872-877
    PubMedSearch in Google Scholar
  • 30 Bouissou H, Julian M, Pieraggi M T, Louge L. Vein morphology.  Phlebology. 1988;  3(suppl 1) 1-11
    PubMedSearch in Google Scholar
  • 31 Lowell R C, Gloviczki P, Miller V M. In vitro evaluation of endothelial and smooth muscle function of primary varicose veins.  J Vasc Surg. 1992;  16 679-686
    CrossrefPubMedSearch in Google Scholar
  • 32 Porto L C, Azizi M A, Pelajo-Machado M, Matos da S P, Lenzi H L. Elastic fibers in saphenous varicose veins.  Angiology. 2002;  53 131-140
    PubMedSearch in Google Scholar
  • 33 Jones G T, Solomon C, Moaveni A, van Rij A M, Thomson I A, Galvin I. Venous morphology predicts class of chronic venous insufficiency.  Eur J Vasc Endovasc Surg. 1999;  18 349-354
    CrossrefPubMedSearch in Google Scholar
  • 34 Ascher E, Jacob T, Hingorani A, Tsemekhin B, Gunduz Y. Expression of molecular mediators of apoptosis and their role in the pathogenesis of lower-extremity varicose veins.  J Vasc Surg. 2001;  33 1080-1086
    CrossrefPubMedSearch in Google Scholar
  • 35 Labropoulos N, Giannoukas A D, Delis K et al.. Where does venous reflux start?.  J Vasc Surg. 1997;  26 736-742
    PubMedSearch in Google Scholar
  • 36 Gandhi R H, Irizarry E, Nackman G B, Halpern V J, Mulcare R J, Tilson M D. Analysis of the connective tissue matrix and proteolytic activity of primary varicose veins.  J Vasc Surg. 1993;  18 814-820
    CrossrefPubMedSearch in Google Scholar
  • 37 Rose S S, Ahmed A. Some thoughts on the aetiology of varicose veins.  J Cardiovasc Surg (Torino). 1986;  27 534-543
    PubMedSearch in Google Scholar
  • 38 Vanhoutte P M, Corcaud S, de Montrion C. Venous disease: from pathophysiology to quality of life.  Angiology. 1997;  48 559-567
    PubMedSearch in Google Scholar
  • 39 Clarke G H, Vasdekis S N, Hobbs J T, Nicolaides A N. Venous wall function in the pathogenesis of varicose veins.  Surgery. 1992;  111 402-408
    PubMedSearch in Google Scholar
  • 40 Travers J P, Brookes C E, Evans J et al.. Assessment of wall structure and composition of varicose veins with reference to collagen, elastin and smooth muscle content.  Eur J Vasc Endovasc Surg. 1996;  11 230-237
    CrossrefPubMedSearch in Google Scholar
  • 41 Michiels C, Arnould T, Thibaut-Vercruyssen R, Bouaziz N, Janssens D, Remacle J. Perfused human saphenous veins for the study of the origin of varicose veins: role of the endothelium and of hypoxia.  Int Angiol. 1997;  16 134-141
    PubMedSearch in Google Scholar
  • 42 Clarke G H, Vasdekis S N, Hobbs J T, Nicolaides A N. Venous wall function in the pathogenesis of varicose veins.  Surgery. 1992;  111 402-408
    PubMedSearch in Google Scholar
  • 43 Alexander C J. The theoretical basis of varicose vein formation.  Med J Aust. 1972;  1 258-261
    PubMedSearch in Google Scholar
  • 44 Haardt B. A comparison of the histochemical enzyme pattern in normal and varicose veins.  Phlebology. 1987;  2 135-158
    PubMedSearch in Google Scholar
  • 45 Barber D A, Wang X, Gloviczki P, Miller V M. Characterization of endothelin receptors in human varicose veins.  J Vasc Surg. 1997;  26 61-69
    PubMedSearch in Google Scholar
  • 46 Johnson B F, Manzo R A, Bergelin R O, Strandness D E. Relationship between changes in the deep venous system and the development of the postthrombotic syndrome after an acute episode of lower limb deep vein thrombosis: a one- to six-year follow-up.  J Vasc Surg. 1995;  21 307-313
    PubMedSearch in Google Scholar
  • 47 Johnson B F, Manzo R A, Bergelin R O, Strandness D E. The site of residual abnormalities in the leg veins in long-term follow-up after deep venous thrombosis and their relationship to the development of the post-thrombotic syndrome.  Int Angiol. 1996;  15 14-19
    PubMedSearch in Google Scholar
  • 48 Killewich L A, Martin R, Cramer M, Beach K W, Strandness D E. An objective assessment of the physiological changes in the postthrombotic syndrome.  Arch Surg. 1985;  120 424-426
    PubMedSearch in Google Scholar
  • 49 Hanrahan L M, Araki C T, Rodriguez A A, Kechejian G J, LaMorte W W, Menzoian J O. Distribution of valvular incompetence in patients with venous stasis ulceration.  J Vasc Surg. 1991;  13 805-811
    CrossrefPubMedSearch in Google Scholar
  • 50 Gooley N A, Sumner D S. Relationship of venous reflux to the site of venous valvular incompetence: implications for venous reconstructive surgery.  J Vasc Surg. 1988;  7 50-59
    PubMedSearch in Google Scholar
  • 51 van Bemmelen P S, Bedford G, Beach K, Strandness Jr D E. Status of the valves in the superficial and deep venous system in chronic venous disease.  Surgery. 1991;  109 730-734
    PubMedSearch in Google Scholar
  • 52 Meissner M H, Caps M T, Zierler B K et al.. Determinants of chronic venous disease after acute deep venous thrombosis.  J Vasc Surg. 1998;  28 826-833
    PubMedSearch in Google Scholar
  • 53 Budd T W, Meenaghan M A, Wirth J, Taheri S A. Histopathology of veins and venous valves of patients with venous insufficiency syndrome: ultrastructure.  J Med. 1990;  21 181-199
    PubMedSearch in Google Scholar
  • 54 Markel A, Manzo R A, Bergelin R O, Strandness D E. Valvular reflux after deep vein thrombosis: incidence and time of occurrence.  J Vasc Surg. 1992;  15 377-384
    CrossrefPubMedSearch in Google Scholar
  • 55 Sevitt S. The mechanisms of canalisation in deep vein thrombosis.  J Pathol. 1973;  110 153-165
    PubMedSearch in Google Scholar
  • 56 Sevitt S. Organization of valve pocket thrombi and the anomalies of double thrombi and valve cusp involvement.  Br J Surg. 1974;  61 641-649
    PubMedSearch in Google Scholar
  • 57 Glas-Greenwalt P, Dalton B C, Astrup T. Localization of tissue plasminogen activator in relation to morphological changes in human saphenous veins used as coronary artery bypass autografts.  Ann Surg. 1975;  181 431-441
    PubMedSearch in Google Scholar

Mark H MeissnerM.D. 

Department of Surgery, Box 359796, Harborview Medical Center

325 9th Avenue, Seattle, WA 98195