Created by Eloise Suan

GREAT VEINS AND THEIR TRIBUTARIES

Superior Vena Cava

- 7 cm in length, formed by the junction of the brachiocephalic veins
- returns blood to the heart from the superior half of the body. It begins behind the lower border of the first right costal cartilage near the sternum
- descends vertically behind the first and second intercostal spaces, and ends in the upper right atrium behind the third right costal cartilage
- inferior half is within the fibrous pericardium, which it pierces level with the second costal cartilage
- has no valves
- anterior margins of the right lung and pleura are anterior, the pericardium intervening below
- Posteromedial are the trachea and right vagus; the right lung and pleura are posterolateral
- right pulmonary hilum is posterior
- Right lateral are the right phrenic nerve and pleura; left lateral are the brachiocephalic artery and ascending aorta
- TRIBUTARIES:
Brachiocephalic:
- TRIBUTARIES:
o Internal Jugular Vein (will be described under veins of the head and neck)
o Vetebral Vein (will be described under veins of the head and neck)
o Subclavian Vein (will be described under deep veins of the upper extremity)
o Azygos Vein
Azygos Vein - typically starts from the posterior aspect of the inferior vena cava, at or below the level of the renal veins
- may pass behind the right crus of the diaphragm or pierce it, or it may traverse the aortic opening on the right of the cisterna chili
- ascends in the posterior mediastinum to the level of the fourth thoracic vertebra, arching forward above the right pulmonary hilum to end in the superior vena cava
- Because of the closeness of the azygos vein to the right posterolateral aspect of the descending thoracic aorta, aortic pulsations may assist venous return in azygos and
hemiazygos veins
- TRIBUTARIES:
o Drains the right posterior intercostal veins except the first, the veins from the second to fourth intercostal spaces usually via a right superior intercostal vein, the
hemiazygos and accessory hemiazygos vein and near its end, right bronchial veins
o Hemiazygos Vein
 hemiazygos vein starts on the left
 ascends anterior to the level of the vertebral column to the eighth thoracic level
 Its tributaries are the lower three posterior intercostal veins, a common trunk formed by the left ascending lumbar and subcostal veins, and oesophageal and
mediastinal branches
o Accessory Hemiazygos Vein
 descends to the left of the vertebral column
 receives veins from the fourth (or fifth) to eighth intercostal spaces and sometimes the left bronchial veins
INFERIOR VENA CAVA
- conveys blood to the right atrium from all structures below the diaphragm
- formed by the junction of the common iliac veins anterior to the fifth lumbar vertebral body, a little to its right
- ascends anterior to the vertebral column, to the right of the aorta
- contained in a deep groove on the posterior surface of the liver, or sometimes in a tunnel completed by a band of liver tissue
- Relations of the Abdominal Part of the Inferior Vena Cava
o related to the right common iliac artery at its origin
o lies behind the peritoneum of the posterior abdominal wall and the third part of the duodenum
o lower three lumbar vertebral bodies, their intervertebral discs and the anterior longitudinal ligament and right psoas major, sympathetic trunk and third and fourth lumbar arteries are all posterior to the inferior vena cava
o the right ureter, the second part of the duodenum, medial border of the right kidney and the right lobe of the liver are all lateral to the right side of the inferior vena cava
o devoid of valves
- Reltation of the thoracic part
o very short
o partly inside and partly outside the pericardial sac
 the extrapericardial part is separated from the right pleura by the right phrenic nerve
 the intrepericardial part is covered, except posteriorly, by the inflected serour pericardium

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- TRIBUTARIES
Lumbar Veins - Four pairs of lumbar veins collect blood by dorsal tributaries from the lumbar muscles and skin
- first lumbar vein may drain directly into the ascending lumbar vein or pass forward over the first lumbar vertebral body to the lumbar azygos vein
- abdominal tributaries to the lumbar veins drain blood from the posterior, lateral and anterior abdominal walls, including the parietal peritoneum
- Near the vertebral column, the lumbar veins drain the vertebral plexuses and are connected by the ascending lumbar vein, which is a vessel running longitudinally anterior to the
roots of the transverse processes of the lumbar vertebrae
Ascending Lumbar Vein - connects the common iliac, iliolumbar and lumbar veins
- between psoas major and the roots of the lumbar transverse processes
- run forward over the twelfth thoracic vertebral body, and pass deep to the crura of the diaphragm and into the thorax
- ascending lumbar vein is usually joined by a small vessel from the back of the of the inferior vena cava or left renal vein on the left represents the azygos line and is referred to as
the lumbar azygos vein
Gonadal Veins
Tesiticular Veins - emerge posteriorly from the testis, drain the epididymis and unite to form the pampiniform plexus, which is a major component of the spermatic cord, and ascends anterior to the vas
deferens
- In the inguinal canal the plexus is drained by three or four veins which run into the abdomen through the deep inguinal ring
- veins join to form single right or left testicular vein
o the right testicular vein opens into the inferior vena cava at an acute angle just inferior to the level of the renal veins
o left testicular vein opens into the left renal vein at a right angle
- contain valves
- Clinical Anatomy:
o Testicular vein in the scrotum and inguinal canal are frequently varicose, which is almost always on the left due to the orthogonal junction of the left testicular vein and
renal veins raises temperature impairs fertility
Ovarian Veins - emerge from the ovary as a plexus (pampiniform plexus) in the mesovarium and suspensory ligament
- usually merge into a single vessel before entering either the inferior vena cava on the right side, or the renal vein on the left side
- may contain valves
- much enlarged during pregnancy
Renal Veins - large calibre vessels, which lie anterior to the renal arteries and open into the inferior vena cava almost at right angles
- left is three times longer than the right in length (7.5 cm and 2.5 cm, respectively)
- left vein lies on the posterior abdominal wall posterior to the splenic vein and body of the pancreas
- right renal vein lies posterior to the second part of the duodenum and sometimes the lateral part of the head of the pancreas
- Clinical Anatomy
o due to its clos relationship with the aorta it may have to ligated in the course of, for example, operation for aneurysm
Suprarenal Vein - right suprarenal vein drains directly into the inferior vena cava at the level of the twelfth thoracic vertebra
Inferior Phrenic Vein - run on the inferior surface of the central tendon of the diaphragm
- drain into the posterolateral aspect of the inferior vena cava around the level of the tenth thoracic vertebra
Common Iliac Veins - will be described under deep veins of the lower extremity
Hepatic Vein - will be described under veins of the abdomen

VEINS OF THE HEAD AND NECK

External Jugular Vein - mainly drains the scalp and face, although it also drains some deeper parts
- formed by the union of the posterior division of the retromandibular vein with the posterior auricular vein and begins near the mandibular angle just below or in the parotid gland
- There are valves at its entrance into the subclavian, but they do not prevent regurgitation. Its wall is adherent to the rim of the fascial opening
- covered by platysma, superficial fascia and skin, and is separated from sternocleidomastoid by deep cervical fascia
- Between the entrance into the subclavian vein and a point about 4 cm above the clavicle, the vein is often dilated, producing a so-called sinus
- TRIBUTARIES
o Posterior External Jugular Vein
 begins in the occipital scalp, and drains the skin and the superficial muscles which lie posterosuperior in the neck
 usually joins the middle part of the external jugular vein
o Anterior Jugular Vein
 arises near the hyoid bone from the confluence of the superficial submandibular veins
 descends between the midline and the anterior border of sternocleidomastoid
 In size it is usually inverse to the external jugular vein

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 communicates with the internal jugular vein, and receives the laryngeal veins and sometimes a small thyroid vein
 There are usually two anterior jugular veins, united just above the manubrium by a large transverse jugular arch, receiving the inferior thyroid tributaries
 No valves
o Posterior Auricular Vein
 arises in a parieto-occipital network that also drains into tributaries of the occipital and superficial temporal veins
 descends behind the auricle to join the posterior division of the retromandibular vein in, or just below, the parotid gland, to form the external jugular vein
 receives a stylomastoid vein and tributaries from the cranial surface of the auricle, drains the region of the scalp behind the ear and drains into the external
jugular vein
Note: discrepancy with the competency again.. It says in the competency that the tributaries of the external jugular vein are: superior thyroid, ascending pharyngeal, lingual,
occipital but according to Grey’s they’re all tributaries of the internal jugular vein
Internal Jugular Vein - collects blood from the skull, brain, superficial parts of face and much of the neck
- begins at the cranial base in the posterior compartment of the jugular foramen, where it is continuous with the sigmoid sinus
- At its origin it is dilated as the superior bulb, which lies below the posterior part of the tympanic floor
- descends in the carotid sheath, and unites with the subclavian vein, posterior to the sternal end of the clavicle, to form the brachiocephalic vein
- TRIBUTARIES
o Inferior Petrosal Sinus
 leaves the skull through the anterior part of the jugular foramen, crosses lateral or medial to the ninth to eleventh cranial nerves and joins the superior jugular
bul
o Lingual Veins
 lingual veins follow two routes
 dorsal lingual veins drain the dorsum and sides of the tongue, join the lingual veins accompanying the lingual artery between hyoglossus and
genioglossus, and enter the internal jugular near the greater cornu of the hyoid bone
 deep lingual vein begins near the tip of the tongue and runs back, lying near the mucous membrane on the inferior surface of the tongue
o Facial Veins
 main vein of the face
 crosses the body of the mandible, and runs in the neck to drain into the internal jugular vein
 The fact that the vein lacks valves and that it is connected with the cavernous sinus is of considerable clinical significance in terms of the spread of infection
o Occipital Veins
 begins in a posterior network in the scalp, pierces the cranial attachment of trapezius, turns into the suboccipital triangle and joins the deep cervical and
vertebral veins
o Pharyngeal Vein
 begin in a pharyngeal plexus external to the pharynx
 receive meningeal veins and a vein from the pterygoid canal, and usually end in the internal jugular vein, but may sometimes end in the facial, lingual or
superior thyroid vein
o Superior Thyroid Vein
 formed by deep and superficial tributaries corresponding to the arterial branches in the upper part of the thyroid gland
 accompanies the superior thyroid artery
 receives the superior laryngeal and cricothyroid veins
 ends in the internal jugular or facial vein
o Middle Thyroid Vein
 drains the lower part of the gland and also receives veins from the larynx and trachea
 crosses anterior to the common carotid artery to join the internal jugular vein behind the superior belly of omohyoid
o Inferior Thyroid Vein
 cervical oesophagus drains into the inferior thyroid vein
o Sagittal Sinuses (I have no idea why these are considered tributaries of the internal jugular vein; they’re supposed to be part of the posterosuperior group of
the Cranial Dural Venous Sinuses)
 Superior Sagittal Sinus
 formed in the suboccipital region by the union of communicating branches of the occipital vein; veins from suboccipital muscles; and veins from
plexuses around the cervical spines.
 It begins near the crista galli, a few millimetres posterior to the foramen caecum, and receives primary tributaries from cortical veins of the frontal
lobes, the ascending frontal veins

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 dilated posterior end of the superior sagittal sinus is referred to as the confluence of the sinuses
 receives the superior cerebral veins, and, near the posterior end of the sagittal suture, veins from the pericranium passing through the parietal
foramina
 the lacunae drain the dipole and meningeal veins
 Inferior Sagittal Sinus
 located in the posterior half or two-thirds of the free margin of the falx cerebri
 increases in size posteriorly, and ends in the straight sinus
 receives veins from the falx and sometimes from the medial surfaces of the cerebral hemispheres
Vertebral Vein - vein emerges from the sixth cervical transverse foramen, whence it descends, at first anterior, then anterolateral, to the vertebral artery, to open superoposteriorly into the
brachiocephalic vein
o the opening has a paired valve
- TRIBUTARIES:
o connects with the sigmoid sinus by a vessel in the posterior condylar canal, when this exists
o also receives branches from the occipital vein, prevertebral muscles, internal and external vertebral plexuses
o Anterior Vertebral Vein
 starts in a plexus around the upper cervical transverse processes, descends near the ascending cervical artery between attachments of scalenus anterior and
longus capitis, and opens into the end of the vertebral vein
o Deep Cervical Vein
 accompanies its artery between semispinales capitis and cervicis
 formed in the suboccipital region by the union of communicating branches of the occipital vein; veins from suboccipital muscles; and veins from plexuses around
the cervical spines

VEINS OF THE UPPER EXTREMITY

DEEP VEINS
Subclavian Vein
- continuation of the axillary vein and extends from the outer border of the first rib to the medial border of scalenus anterior, where it joins the internal jugular vein to form the brachiocephalic vein
- vein usually has a pair of valves, about 2 cm from its end
- the left subclavian receives the thoracic duct: the right subclavian vein receives the right lymphatic duct
Axillary Vein - continuation of the basilic vein
- begins at the lower border of teres major, and ascends to the outer border of the first rib, where it becomes the subclavian vein
- lies medial to the axillary artery, which it partly overlaps
- medial cutaneous nerve of the arm is medial to the vein; the lateral group of axillary lymph nodes is posteromedial
- there are a pair of valves near its distal end, and valves also occur near the ends of the cephalic and subscapular veins
Brachial Veins - flank the brachial artery, as venae comitantes with tributaries similar to the arterial branches; near the lower margin of subscapularis they join the axillary vein
- Radial Vein
o smaller, and receive the deep dorsal veins of the hand
- Ulnar Vein
o drain the deep palmar venous arch, and connect with superficial veins near the wrist
o Near the elbow they receive the venae comitantes of the anterior and posterior interosseous arteries, and a large branch connects them to the median cubital vein
- Palmar Venous Arches
o accompany their arterial counterparts and receive the corresponding branches
o common palmar digital veins join the superficial arch, and palmar metacarpal veins join the deep arch
SUPERFICIAL VEINS
Cephalic Veins - usually forms over the 'anatomical snuff-box' from the radial end of the dorsal venous plexus
- Distal to the elbow a branch, the median cubital vein, diverges proximomedially to reach the basilic vein
- median cubital vein is joined by a branch from the deep veins
- Accessory Cephalic Vein
o may arise either in a dorsal forearm plexus or from the ulnar side of the dorsal venous network in the hand
o joins the cephalic vein distal to the elbow
Basilic Vein - starts medially in the dorsal venous network of the hand
- ascends posteromedially in the forearm, inclining forwards to the anterior surface distal to the elbow, where it is joined by the median cubital vein
- crossed by filaments of the medial cutaneous nerve of the forearm which pass both superficial and deep to the vein
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Median Vein - drains the superficial palmar venous plexus and ascends through the anterior part of the forearm to join either the basilic or median cubital vein
- may divide distal to the elbow to join both veins
Median Cubital Vein - usually palpable, especially if the venous return is occluded proximally by a tourniquet
- usually arises from the cephalic vein 2.5 cm distal to the lateral epicondyle of the humerus and runs upwards and medially to join the basilic vein 2.5 cm above the transverse crease
of the elbow
- bicipital aponeurosis is crossed by the median cubital vein, which runs medially and proximally from the cephalic vein to join the basilic vein
Dorsal Venous Arch - Dorsal digital veins receive rami from the plantar digital veins in the clefts between the toes and then join to form dorsal metatarsal veins, which are united across the proximal parts
of the metatarsal bones in a dorsal venous arch

VEINS OF THE ABDOMEN

- lumbar, renal, gonadal and suprarenal are described under the inferior vena cava
Hepatic Vein - drain the liver, commencing as intralobular veins, draining the sinusoid of liver lobules lead to sublobular veins united into hepatic veins
- emerges from the posterior hepatic surface to open at once into the inferior vena cava
Hepatic Portal System
- includes all the veins draining the abdominal part of the digestive tube with the exception of the lower anal canal, but including the abdominal part of the oesophagus
- also drains the spleen, pancreas and gallbladder
- portal vein and its tributaries have no valves
- blood passes through two set “exchange” vessels
o capillaries of the digestive tube, spleen, pancreas and gallbladder
o hepatic sinusoids
Portal Vein
- begins at the level of the second lumbar vertebra and is formed from the convergence of the superior mesenteric and splenic veins
- It is about 8 cm long and lies anterior to the inferior vena cava and posterior to the neck of the pancreas
- enters the right border of the lesser omentum, and ascends anterior to the epiploic foramen to reach the right end of the porta hepatic
- divides into right and left main branches which accompany the corresponding branches of the hepatic artery into the liver
- as it enters the left lobe it is joined by para-umbilical veins and the ligamentum teres, which contains the functionless and partly obliterated left umbilical vein
- connected to the inferio vena cava by the ligamentum venosum¸a vestige of an obliterated ductus venosus
- TRIBUTARIES
Splenic Vein - formed by five or six tributaries emerging from the hilum of the spleen
- actually formed within the splenorenal ligament close to the tip of the tail of the pancreas
- thin walled and often spread over several centimetres as the hilum is long and thin
- ends behind the neck of the pancreas, where it joins the superior mesenteric vein to form the portal vein
- short gastric and left gastro-epiploic veins drain into the splenic vein through the folds of the gastrosplenic ligament near its origin
- TRIBUTARIES
o Short Gastric Veins
 Four or five short gastric veins drain the gastric fundus and the upper part of the greater curvature.
 drain into the splenic vein or one of its large tributaries
o Left Gastro-epiploic Veins
 drains both anterior and posterior gastric surfaces and the adjacent greater omentum
 receives multiple tributaries from the anterior and posterior surfaces of the body of the stomach and the greater omentum, and drains into the splenic vein within
the gastrosplenic ligament
o Pancreatic Veins
 Drain the body and tail of the pancreas
o Inferior Mesenteric Vein
 Drains the rectum, and sigmoid and descending parts of the colon
 Begins as the superior rectal vein
 Passes above or behind the duodenal flexure, opening into the splenic vein
Superior Mesenteric Vein - Drains the small intestine, caecum and ascending and transverse parts of the colon
- Ascends in the mesentery on the right of the superior mesenteric artery
- Joins the splenic vein behind its neck to form the portal vein
- TRIBUTARIES
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o Right Gastro-Epiploic Vein
 drains the greater omentum, distal body and antrum of the stomach
 passes medially, inferior to the greater curvature, in the upper portion of the gastrocolic omentum
 may receive the superior pancreaticoduodenal vein close to its entry into the superior mesenteric vein
o Pancrestico-duodenal vein
 Accompany their corresponding arteries
o Left Gastric Vein
 drains the upper body and fundus of the stomach
 ascends along the lesser curvature to the oesophageal opening where it receives several lower oesophageal veins
 drains into the portal vein directly at the level of the upper border of the first part of the duodenum
o Right Gastric Vein
 typically small and runs along the medial end of the lesser curvature
 drains directly into the portal vein at the level of the first part of the duodenum
 receives the prepyloric vein as it ascends anterior to the pylorus at the level of the pyloric opening.
o Para-Umbilical Vein
 Connecting veins of the anterior abdominal wall and portal vein
 Extend along the ligamentum teres and median umbilical ligament
 End in the left branch of the portal vein
o Cystic Vein
 Drain the gallbladder

VEINS OF THE LOWER EXTERMITY

DEEP VEINS
Common Iliac Vein
- formed by the union of external and internal iliac veins, anterior to the sacroiliac joints
- ascends obliquely to end at the right side of the fifth lumbar vertebra, uniting at an acute angle with the contralateral vessel to form the inferior vena cava
- right common iliac vein is shorter and more nearly vertical, lying posterior then lateral to its artery
- left common iliac vein is longer and more oblique and lies first medial, then posterior to its artery. It is crossed anteriorly by the attachment of the sigmoid mesocolon and superior rectal vessels
o usually drains the median sacral vein
o no valves

Internal Iliac Vein - formed by the convergence of several veins above the greater sciatic foramen
- ascends posteromedial to the internal iliac artery to join the external iliac vein, forming the common iliac vein at the pelvic brim, anterior to the lower part of the sacroiliac joint
- if external iliac is blocked nternal iliac tributaries, enlarge and provide a major avenue of venous return from the femoral system
- TRIBUTARIES
o Superior Gluteal Veins
 venae comitantes of the superior gluteal artery
 receive branches corresponding to branches of the artery and enter the pelvis via the greater sciatic foramen, above piriormis
o Inferior Gluteal Veins
 venae comitantes of the inferior gluteal artery.
 begin proximally and posterior in the thigh, where they anastomose with the medial circumflex femoral and first perforating veins
 connect with the superficial gluteal veins by perforating veins analogous to the sural perforating veins
 probably have a venous 'pumping' role, and provide collaterals between the femoral and internal iliac veins
o Obturator Vein
 begins in the proximal adductor region and enters the pelvis via the obturator foramen
 runs posteriorly and superiorly on the lateral pelvic wall below the obturator artery and between the ureter and internal iliac artery
o Lateral Sacral Vein
 accompany the lateral sacral arteries, and are interconnected by a sacral venous plexus
o Middle Rectal Vein
 begins in the rectal venous plexus and drains the rectum and mesorectum
 often receives tributaries from the bladder and the prostate and seminal vesicle (males) and the posterior aspect of the vagina (females)
External Iliac Vein - proximal continuation of the femoral vein
- begins posterior to the inguinal ligament, ascends along the pelvic brim and ends anterior to the sacroiliac joint by joining the internal iliac vein to form the common iliac vein
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- vein is usually valveless, but may contain a single valve
- TRIBUTARIES
o Inferior Epigastric Vein
 One or two inferior epigastric veins accompany the artery and drain into the external iliac vein a little above the inguinal ligament
o Deep Circumflex iliac vein
 formed from venae comitantes of the corresponding artery
 joins the external iliac vein a little above the inferior epigastric veins after crossing anterior to the external iliac artery
o Pubic Vein
 joins the external iliac vein a little above the inferior epigastric veins after crossing anterior to the external iliac artery
SUPERFICIAL VEIN
Long/Great Saphenous Vein - longest vein in the body, starts distally as a continuation of the medial marginal vein of the foot, and ends in the femoral vein a short distance distal to the inguinal ligament
- 'centre' of the opening is often said to be 2.5-3.5 cm inferolateral to the pubic tubercle, and the vein is then represented by a line drawn from this point to the femoral adductor
tubercle  saphenous opening varies greatly
- At the knee the saphenous branch of the descending genicular artery (the saphenous artery) and, in the leg and foot, the saphenous nerve, are anterior to it
- vein is often duplicated, especially distal to the knee
- has from 10 to 20 valves, which are more numerous in the leg than the thigh
- TRIBUTARIES
o At the ankle the long saphenous vein drains the sole by medial marginal veins
o Just distal to the knee it usually receives three large tributaries: from the front of the leg, from the tibial malleolar region (connecting with some of the 'perforating' veins)
and from the calf (communicating with the short saphenous vein)
o In the thigh the long saphenous vein receives many tributaries
 These may be grouped as follows: one or more large posteromedial tributaries, one or more large anterolateral tributaries, four or more peri-inguinal veins
Short/Small Saphenous Vein - begins posterior to the lateral malleolus as a continuation of the lateral marginal vein
- passes between the heads of gastrocnemius then proceeds to its termination in the popliteal vein in the popliteal fossa
- TRIBUTARIES
o short saphenous vein connects with deep veins on the dorsum of the foot, receives many cutaneous tributaries in the leg, and sends several communicating branches
proximally and medially to join the long saphenous vein
o In the leg the short saphenous vein lies near the sural nerve
o It has 7-13 valves, one near its termination. Its mode of ending is variable: it may join the long saphenous vein in the proximal thigh or it may bifurcate, one branch joining
the long saphenous, the other the popliteal or deep posterior femoral veins
Dorsal Venous Arch - forms a conspicuous feature on the dorsum of the foot and curves, convex forwards, across the metatarsus
- long saphenous vein arises from its medial end and runs upwards and backwards immediately in front of the medial malleolus
- The short saphenous vein arises from the lateral end of the arch and passes backwards and inferior to, and then upwards and posterior to, the lateral malleolus.