Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000068.xml
Download PDF
Semin intervent Radiol 2005; 22(3): 147-156
DOI: 10.1055/s-2005-921948
DOI: 10.1055/s-2005-921948
Lower Extremity Venous Anatomy
Further Information
Publication History
Publication Date:
27 October 2005 (online)
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: 3-20MissingFormLabel - 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
- 3 Stewart G J. Neutrophils and deep venous thrombosis. Haemostasis. 1993; 23(suppl 1) 127-140
- 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: 3-26MissingFormLabel - 5 Browse N, Burnand K, Thomas M. Diseases of the Veins: Pathology, Diagnosis, and Treatment. London; Edward Arnold 1988
MissingFormLabel
- 6 van Bemmelen P S, Beach K, Bedford G, Strandness D E. The mechanism of venous valve closure. Arch Surg. 1990; 125 617-619
- 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
- 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
- 9 Somjen G M. Anatomy of the superficial venous system. Dermatol Surg. 1995; 21 35-45
- 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
- 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
- 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
- 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: 11-24MissingFormLabel - 14 Cotton L T. Varicose veins: gross anatomy and development. Br J Surg. 1961; 48 589-597
- 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
- 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
- 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: 18-49MissingFormLabel - 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: 49-57MissingFormLabel - 19 Porter J, Moneta G. Reporting standards in venous disease: an update. J Vasc Surg. 1995; 21 635-645
- 20 Goldman M P, Fronek A. Anatomy and pathophysiology of varicose veins. J Dermatol Surg Oncol. 1989; 15 138-145
- 21 Ludbrook J. The musculovenous pumps of the human lower limb. Am Heart J. 1966; 71 635-641
- 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
- 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
- 24 Nicolaides A N. Investigation of chronic venous insufficiency: a consensus statement (France, March 5-9, 1997). Circulation. 2000; 102 E126-E163
- 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
- 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
- 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
- 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
- 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
- 30 Bouissou H, Julian M, Pieraggi M T, Louge L. Vein morphology. Phlebology. 1988; 3(suppl 1) 1-11
- 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
- 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
- 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
- 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
- 35 Labropoulos N, Giannoukas A D, Delis K et al.. Where does venous reflux start?. J Vasc Surg. 1997; 26 736-742
- 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
- 37 Rose S S, Ahmed A. Some thoughts on the aetiology of varicose veins. J Cardiovasc Surg (Torino). 1986; 27 534-543
- 38 Vanhoutte P M, Corcaud S, de Montrion C. Venous disease: from pathophysiology to quality of life. Angiology. 1997; 48 559-567
- 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
- 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
- 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
- 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
- 43 Alexander C J. The theoretical basis of varicose vein formation. Med J Aust. 1972; 1 258-261
- 44 Haardt B. A comparison of the histochemical enzyme pattern in normal and varicose veins. Phlebology. 1987; 2 135-158
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 55 Sevitt S. The mechanisms of canalisation in deep vein thrombosis. J Pathol. 1973; 110 153-165
- 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
- 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
Mark H MeissnerM.D.
Department of Surgery, Box 359796, Harborview Medical Center
325 9th Avenue, Seattle, WA 98195