Lower Limb Veins and Lymphatics

Question 1

What are the two types of venous return in the lower limb?

Answer 1

1. Deep (accompanying arteries)

2. Superficial (close to limb surface)

Question 2

How do you know deep veins?

Answer 2

follow arteries

Question 3

Why are many of the deep veins not single?

Answer 3

many distal veins form venae comitantes

Question 4

What is different between deep veins and arteries?

Answer 4

pass through the limb together blood flow is in the opposite direction, arterial flow is proximal to distal and venous flow is distal to proximal

Question 5

What are venae comitantes?

Answer 5

Veins which accompany arteries as groups of smaller veins instead of a single larger vein as is more typical in organs and tissues

Question 6

What are groups of venae comitatnes like?

Answer 6

usually in pairs or may be in groups of 3 or 4 in some instances and tend to be connected by smaller veins

Question 7

Why is the arrangement of venae comitatnes good?

Answer 7

1. vessel are intimately associated and it is believed that the pulsation of the arteries squeezes the veins helping to increase the venous return by squeezing the venous blood through the valves
2. Allows warming of blood on its way back to trunk that has been cooled at extremities

Question 8

What blood flow do the valves in the veins mean?

Answer 8

allows flow up to the heart

Question 9

What is the calf pump?

Answer 9

• In the leg the deep veins are sandwiched between layers of calf muscles
• During walking and running contraction of these muscles squeeze the thin walled veins and push blood up towards the heart and this is the calf pump

Question 10

What can prolonged immobility e.g. long plane journey lead to?

Answer 10

1. less efficient venous return from foot and leg
2. sluggish deep venous return can lead to deep vein thrombosis (DVT)
3. dangerous

Question 11

How can you prevent DVT? How do they work?

Answer 11

1. wearing elastic surgical socks or stockings 2. compresses the superficial veins
2. promoting more of the venous return through the deep pathway
3. this in turn leads to a more vigorous deep venous return reducing the risk of thrombosis formation

Question 12

Where does the long saphenous vein drain?

Answer 12

into femoral vein

Question 13

What does the short saphenous vein drain?

Answer 13

into popliteal vein

Question 14

What is the general pattern of superficial venous return?

Answer 14

1. small veins in the digits and foot drain into a superficial dorsal venous network and a plantar venous network
2. which at the ankle forms two large veins that run proximally up the limb these are the long saphenous vein and the short saphenous vein (they are sometimes called the great and small saphenous veins)

Question 15

What is the journey of the long saphenous vein?

Answer 15

1. passes from the foot anteriorly
2. to the medial malleolus
3. courses up the leg to the medial side of the knee
4. passes medially and anteriorly in the thigh
5. To pierce the fascia lata
6. Drain into the femoral vein

Question 16

What is the journey of the short saphenous vein?

Answer 16

1. formed as it passes posteriorly to the lateral malleolus
2. Continues coursing proximally on the posterior leg to the knee
3. where it peirces the fascia covering the popliteal fossa
4. drain into the popliteal vein

Question 17

When are the superficial veins of the lower limb harvested?

Answer 17

venous grafts most commonly for coronary artery bypass grafts

Question 18

How are superficial and deep veins connected?

Answer 18

by perforating veins

Question 19

What are perforating veins?

Answer 19

have a single valve that allowed flow from superficial to deep

Question 20

What happens if the valves become compromised?

Answer 20

results in back flow to the superficial veins causing them to swell and bulge and these visible swellings are varicose veins

Question 21

What are varicose veins?

Answer 21

• painful
• lead to surface lesions
• may also contribute to the sluggish deep venous return that can increase the risk of DVT

Question 22

What do lymphatic vessels usually run with?

Answer 22

runs with veins in most organs and tissues

Question 23

What do popliteal nodes usually drain?

Answer 23

distal limb

Question 24

What do inguinal nodes usually drain?

Answer 24

drain limb and pudendal region, peineum, anus and parts of the lower abdomen

Question 25

What are the two components of lymphatic drainage?

Answer 25

superficial and deep components

Question 26

What do the posterior lymph vessels run with superficially?

Answer 26

• short saphenous vein to drain into the popliteal nodes in the popliteal fossa
• drainage continues with deep flow associated with the femoral vein

Question 27

Where do the vessels running with the long saphenous vein drain?

Answer 27

into the superficial inguinal nodes in the inguinal region close to the saphenous opening and the inguinal ligament

Question 28

What is the deep lymphatic drainage?

Answer 28

via lymph vessels running with the deep veins

Question 29

What is drainage from the distal lower limb?

Answer 29

some passes through the popliteal nodes while most of the drainage is into the deep groups of inguinal nodes

Question 30

How does the lymphatic drainage of the lower limb ultimately continue?

Answer 30

via iliac vessels passing through the lilac nodes

Question 31

What are the important anatomical spaces of the lower limb?

Answer 31

1. Femoral triangle

2. Popliteal fossa

Question 32

What are the outlines of the femoral triangle?

Answer 32

1. inguinal ligament
2. lateral border of adductor longus muscle (medially)
3. medial border of satoris muscle (laterllaY)

Question 33

What is in the femoral triangle?

Answer 33

1. Femoral nerve (most laterla)
2. Femoral artery
3. Femoral vein
4. Superficial and deep lymph nodes

Question 34

What is the femoral triangle covered with?

Answer 34

skin and deep fascia (the fascia lata)

Question 35

What does an opening in the fascia lata allow?

Answer 35

the long saphenous vein enters the triangle to drain into the femoral vein

Question 36

What happens when the femoral nerve enters the femoral triangle?

Answer 36

ceases to be a large nerve giving off its many terminal branches supplying its muscular and cutaneous targets

Question 37

Why is the femoral triangle important?

Answer 37

1. femoral arterial pulse can be palpated here
2. Both the artery and the vein can be accessed for catheritisation for procedures involving the coronary arteries and other parts of the heart
3. The triangle also contains superficial and deep lymph nodes

Question 38

What is the popliteal fossa outlined by?

Answer 38

1. Superiorly: semimebranosis and biceps femoris muscles
2. Inferiorly: lateral and medial heads of gastrocnemius muscles
   - diamond shaped space behind the knee joint which is bounded by the hamstrings superiorly and the two heads of gastrocnemius inferiorly

Question 39

What does the popliteal fossa contain?

Answer 39

1. Tibial and common peroneal nerves (formed by the bifurcation of the sciatic nerve usually just superior to the fossa)
2. Popliteal artery and vein
3. Popliteal lymph nodes

Question 40

What is the fascia covering the popliteal fossa pieced by?

Answer 40

the short saphenous vein which enters the fossa to drain into the popliteal vein

Question 41

Why is the popliteal fossa important?

Answer 41

1. The pulse of the popliteal artery is palpated here

2. In life this space is usually packed with adipose tissue and it contains the popliteal lymph nodes