Venous system anatomy perfusionist lect.pptx

Venous system anatomy
lecture for M.Sc. Perfusionist students
Dr. Workneh T.(Asst Prof of G. surgery
and cardiothoracic surgery fellow)

Outline
• Introduction
• Veins of head and neck
• Veins of upper limbs
• Veins of thorax
• Veins of abdomen
• Veins of lower limbs
1/22/2024 venos system anatomy 2

Introduction
Arteries:
• Distribute blood to various
parts
• Are deeply situated.
• Follow definite pathways.
Veins:
• Drain blood from them.
• Superficial or deep.
• More difficult to follow
• connect in irregular network

Cont’d…
3 systemic veins drain to the heart;
• Coronary sinus
• IVC
• SVC

CORONARY SINUS:
• Main vein of
heart.
• Located in
coronary sulcus.
• Opens into the
right atrium
between the
orifice of IVC and
tricuspid valve.

Cont’d…
Recieves blood from 3 veins
• Great cardiac vein: ant.
Interventricular sulcus
joins at the left end.
• middle cardiac vein: (PIVS)
• small cardiac vein on its
right end.
• Ant. Cardiac veins open
directly into the right
atrium

IVC
• Largest vein of the body.
• Begins ant. To L5 by the union of CIV ascends behind the
peritoneum to the right of midline pierces the caval opening
of diaphragm at T8 enters inferior part of right atrium.
• Drains abdomen, pelvis and lower limbs.

SVC
• Empties blood into superior part of right atrium.
• Begins posteriorly to the right first costal cartilage by the
union of right and left brachiocephalic veins and ends at level
of 3rd costal cartilage — enters right atrium.
• Drains head, neck, chest and upper limbs

Veins of head and neck:
• Most blood draining from the head passes into 3 pairs of veins
— internal jugular, external jugular, and vertebral veins.
• Within the brain, all veins drain into dural venous sinuses and
then into the int. jugular veins.
• Dural venous sinuses are endothelial lined venous channels
between layers of cranial dura matter.

INTERNAL JUGULAR VEINS:
• from the dural venous sinuses
blood flows into the internal
jugular veins:
• Right and left internal jugular
veins — pass inferiorly on either
side of the neck lateral to the
internal carotid and common
carotid arteries.

Cont’d…
• Unite with the subclavian veins
posterior to the clavicles at the
sternoclavicular joints to form the
right and left brachicephalic
veins.
• From here blood flows into the
SVC.
• General structures drained by the
internal jugular veins are the
brain, face and neck.

EXTERNAL JUGULAR VEINS
• Right and left ext. jugular veins begin in the parotid glands
near the angle of the mandible.
• Superficial veins that descend through the neck across the
sternocleidomastoid muscles.
• Terminate at a point opposite the middle of the clavicles,
where they empty into the subclavian veins.

Cont’d…
• Drain structures external to the
cranium, such as scalp and
superficial and deep regions of
the face.
• When venous pressure rises,
during heavy coughing or
straining or in cases of heart
failure, the EJV become very
prominent along the side of the
neck.

VERTEBRAL VEINS:
• Right and left vertebral veins originate inferior to the occipital
condyles.
• Descend through successive transverse foramina of the first 6
cervical vertebrae and emerge from the foramina of the 6th
cervical vertebra to enter the brachiocephalic veins in the root
of the neck.
• Drain deep structures in the neck such as the cervical
vertebrae, cervical spinal cord, and prevertebral and
suboccipital muscles.

Veins of the upper limbs
• Both superficial and deep veins return blood from the upper
limbs to the heart.
• Superficial veins are located just deep to the skin and are
often visible.
• Anastomose extensively with one another and with deep
veins, and they don’t accompany arteries.
• Superficial veins are larger than deep veins and return most of
the blood from the upper limbs.

Cont’d…
• Deep veins are located deep in the body.
• Usually accompany arteries and have the same names as the
corresponding arteries.
• Both have valves; more numerous in deep veins.

Superficial veins:
• Cephalic veins:
• Principal superficial veins that drain upper limbs are cephalic
and basilic veins.
• Originate in the hand and convey blood from the smaller
superficial veins into the axillary veins.
• Cephalic veins begin on the lateral aspect of the ‘dorsal
venous arches’. (networks of veins on the dorsum of the
hands formed by the ‘dorsal metacarpal veins’.)
• Course around the radial side of the forearms to the ant.
Surface and ascend through the entire limbs.

Cont’d…
• End where they join the axillary veins, just inferior to the
clavicles.
• Accessory cephalic veins originate either from a venous plexus
on the dorsum of the forearms or from the medial aspects of
the dorsal venous networks of the hands, and unite with
cephalic veins just inferior to the elbow.
• Drain blood from the lateral aspect of the upper limbs.

Cont’d…
• Basilic veins:
• Begin on the medial aspects of the dorsal venous arch and
ascend along the posteromedial surface of the forearm and
anteromedial surface of the arm.
• Drain blood from the medial aspects of the upper limbs.
• Ant. To the elbow, basilic veins are connected to the cephalic
veins by the median cubital veins which drain the forearm.

Cont’d…
• If veins must be punctured for an injection, transfusion, or
removal of a blood sample, the medial cubital veins are
preferred.
• After receiving median cubital veins, basilic veins continue
ascending until they reach the middle of the arm.
• Penetrate the tissues deeply and run alongside the brachial
arteries until they join the brachial veins.
• As the basilic and brachial veins merge in the axillary,area,
they form the axillary veins.

Cont’d…
Deep veins:
1 Radial veins:
• Paired radial veins begin at the deep palmar venous arches.
• Arches drain the palmar metacarpal veins in the palms.
• Drain lateral aspects of forearms and pass alongside the radial
arteries.
• Just inferior to the elbow joint, the radial veins unite
with the ulnar veins to form brachial veins.

Cont’d…
2.Ulnar veins:
• Paired — larger than the radial veins — begin at the
superficial palmar venous arches.
• Drain the common palmar digital veins and the proper palmar
digital veins in the fingers.
• Ulnar veins drain the medial aspect of the forearms, pass
alongside the ulnar arteries, and join with the radial veins to
form the brachial veins.

Cont’d…
3. Brachial veins:
• Paired, accompany brachial arteries.
• Drain forearms, elbow joints, arms and humerus.
• Join with the basilic veins to form axillary veins.
4. Axillary veins:
• Ascend to the outer borders of the first ribs to become
subclavian veins.
• Tributaries: correspond with branches of axillary a.
• Drain the arms, axillas, and superolateral chest wall.

Cont’d…
5. Subclavian veins:
• Continuations of the axillary veins that terminate at the
sternal end of the clavicles unite with the internal jugular
veins to form the brachiocephalic veins.
• Subclavian veins drains the arms, neck, and thoracic wall.
• Thoracic duct of the lymphatic system delivers lymph into the
junction between the left subclavian and the left internal
jugular veins.
• Right lymphatic duct delivers lymph into the junction between
right subclavian and right internal jugular veins.

Cont’d…
• In a procedure called ‘central line placement’, the right
subclavian vein is frequently used to administer nutrients and
medication and
measure venous pressure.

Veins of thorax:
• Brachiocephalic veins drain some portions of the thorax, most
thoracic structures are drained by a network of veins, called
the azygous system — runs on either side of the vertebral
column.
• Azygous System consists of 3 veins — azygos, hemiazygous,
and accessory hemiazygous veins.
• Ultimately they empty into the SVC.

Cont’d…
Brachiocephalic vein:
• Right and left brachiocephalic veins formed by the union of
the subclavian and internal jugular veins
• drain blood from the neck, upper limbs, mammary glands,
and superior thorax.
• BCV unite to form the SVC.

Cont’d…
Azygous system:
• Collects blood from the thorax and the abdominal Wall.
• Serves as a bypass for the IVC that drains blood from the
lower body.
• Several small veins directly link the azygous system with the
IVC.
• If the IVC or portal system becomes obstructed, the azygous
system can return blood from lower body to the SVC.

Cont’d…
• Azygous vein:
• Goes ant. To the vertebral column.
• Slightly to the right of the midline.
• Begins at the junction of left ascending lumbar and right
subcostal veins near the diaphragm.
• At the level of T4, it arches over the rt main bronchus to end
in SVC.
• Azygous vein drains the right side of thoracic wall, thoracic
viscera, and abd. Wall
• Receives blood from right posterior intercostal, hemiazygous,
esophageal, acc. Hemiazygous, mediastinal, pericardial, and
bronchial veins.

Cont’d…
• Hemiazygous vein: inferior
• Ant. Of vertebral column.
• Slightly to the left of the midline.
• Often brings at the junction of left asecending lumbar and left
subcostal veins.
• Terminates by joining azygous vein at about the level of T9.
• Drains the left side of thoracic wall, thoracic viscera, and
abdominal wall.
• Receives blood from 9th to 11th left post. Intercostal,
esophageal and mediastinal veins.

Cot’d…
Accessory hemiazygous vein: superior
• Left of the midline.
• Begins at the 4th or 5th intercostal space.
• Descends from the 5th to 8th thoracic vertebra or ends in the
hemiazygous vein.
• Terminates by joining the azygous vein at about the level of
the 8th thoracic vertebra.
• Drains the left side of the thoracic wall.
• Receives blood from the 4th to 8th left posterior intercostal
veins, left bronchial, left superior intercostal vein and
mediastinal veins.

Veins of the abdomen and pelvis:
• Blood from the abdominal and pelvic viscera and abdominal
wall returns to the heart via the IVC.
• IVC doesn’t receive veins directly form the GIT, spleen,
pancreas, and GB.
• These organs pass their blood into a common vein, the
hepatic portal vein, which delivers the blood to the liver.
• Superior mesenteric and splenic veins unite to form the
hepatic portal vein.

Cont’d…
• Special flow of venous blood called the ‘hepatic portal
circulation’.
• After passing through the liver for processing, blood drains
into the hepatic veins, which empty into the IVC.

IVC:
• 2 common iliac veins that drain the lower limbs, pelvis, and
abdomen unite to form the IVC.
• Extends superiorly through the abdomen and thorax to the
right atrium.

Cont’d…
COMMON ILIAC VEINS:
• Formed by union of the internal and external iliac veins ant. to
the sacroiliac joint.
• Represent the distal continuation of the IVC at their
bifurcation.
• Right is shorter than left.
• Drain the pelvis, external genitals, and lower limbs.

Cont’d…
INTERNAL ILIAC VEINS:
• Begin near the superior portion of the greater sciatic notch
and run medial to their corresponding arteries.
• Drain thigh, buttocks, external genitals and pelvis.
• Companions of the internal iliac arteries.

Cont’d…
EXTERNAL ILIAC VEINS:
• Begin at the inguinal ligaments as continuations of the
femoral veins.
• End anterior to the sacroiliac joint where they join with the
internal iliac veins to form the common iliac veins
• Drain lower limbs, cremaster muscle in males, and the
abdominal wall.

Cont’d…
LUMBAR VEINS:
• Series of parallel veins — 4 on each side —drain blood from
both sides of post. Abd. Wall, vertebral canal, spinal cord, and
meninges.
• Run horizontally with the lumbar arteries.
• Connect at right angles with the right and left ascending
lumbar veins — form the origin of the corresponding azygous
or hemiazygous vein.
• Drain blood into the ascending lumbars and then run into the
IVC.

Cont’d…
RENAL VEINS:
• renal veins pass anterior to the renal arteries at the hilum
• Left is longer than right.
• Left receives left testicular vein (or ovarian vein),
inferior phrenic vein, usually left suprarenal veins.
• Right renal vein empties into the IVC posterior to the
duodenum.
• Drain kidneys

Veins of the lower limbs:
• Blood is drained from lower limbs by superficial and deep
veins.
• Superficial veins often anastomose with one another and with
deep veins along their length.
• Deep veins have the same names as corresponding arteries.
• All veins of the lower limbs have valves — which are more
numerous than in veins of the upper limbs.

Superficial veins:
1. Great saphenous veins:
• Longest veins in the body — ascend from the foot to the groin
in the subcutaneous layer.
• Begin at the medial end of the dorsal venous arches of the
foot.
• Dorsal venous arches are networks of veins on the dorsum of
the foot formed by the dorsal digital veins
• Great saphenous veins pass ant. To the medial malleolus of
the tibia and then along the medial aspect of the leg and thigh
just deep to the skin

Cont’d…
• Receive tributaries from superficial tissues and
connect with the deep veins as well.
• Empty into the femoral veins at groin.
• Drain mainly the medial side of the
leg and thigh,groin, ext. genitals and
abd. Wall.
• Along their length, great saphenous
veins have 10-20 valves more in
leg than in thigh.

Cont’d…
• These veins are more likely to be subject to varicosities
because they must support a long column of blood and aren’t
well supported by skeletal muscles.
• Can be used for prolonged administration of IVF.
• Important for patients who are in shock and whose veins are
collapsed.

Cont’d…
• Coronary bypass grafting — if
multiple blood vessels need to be
grafted, sections of great saphenous
vein are used along with at least one
artery as a graft.
• Vein grafts are reversed so that
valves don’t obstruct the blood flow.

Cont’d…
2. Small saphenous veins:
• Begin at the lateral aspect of the dorsal venous arches of the
foot.
• Pass posterior to the lateral malleolus of the fibula and ascend
deep to the skin along the posterior aspect of the leg.
• Empty into popliteal veins in the popliteal fossa, post. To the
knee.
• Drain foot and posterior aspect of the leg.

Deep veins:
Posterior tibial veins:
• Plantar digital veins unite to form the deep plantar venous
arches then, Medial and lateral plantar veins
• Medial and lateral plantar veins, posterior to the medial
malleolus of the tibia, form the paired posterior tibial veins,
which sometime merge into a single vessel.
• Accompany the posterior tibial artery through the leg

Cont’d…
• Ascend deep to the muscles in the posterior aspect of the leg
and drain the foot and posterior compartment muscles.
• 2/3rds of the way up the leg, the posterior tibial veins drain
blood from the fibular veins, which drain lateral and posterior
leg muscles.
• Posterior tibial veins unite with the anterior tibial veins just
inferior to the popliteal fossa to for the popliteal veins.

Cont’d…
Anterior tibial veins:
• Paired, arise in the dorsal venous arch and accompany the
ant. Tibial artery.
• Ascend in the interosseous membrane between the tibia and
fibula and unite with the posterior tibial veins to form the
popliteal vein.
• Drains ankle joint, knee joint, tibiofibular joint, and ant.
Portion of the leg

Cont’d…
• Popliteal veins:
• Formed by union of the ant. And post. Tibial veins.
• Also receive blood from the small saphenous veins and
tributaries that correspond to branches of the popliteal artery.
• Drain knee joint, and the skin, muscles, bones of portions of
the calf and thigh around the knee joint.

Cont’d…
• Femoral veins:
• Accompany femoral arteries and are the
continuation of popliteal veins just superior to
the knee.
• Extend up the post. Surface of thighs and
drains the muscles of the thigh, femurs, ext.
genitals etc
• Just before penetrating the abd. Wall, they
receive deep femoral and great saphenous
veins.

Cont’d..
• After entering the pelvic cavity — external iliac veins.
• In order to take blood samples or pressures recordings from
the right side of the heart, a catheter is inserted into the
femoral vein as it passes through the femoral triangle.
• Catheter passes through the external and common iliac veins
and IVC into the right atrium.

Hepatic portal circulation:
• Carries venous blood from the GIT organs and spleen to the
liver.
• A vein that carries blood from one capillary network to
another is called a ‘portal vein’.
• Hepatic portal vein receives blood from capillaries of GIT
organs and the spleen and delivers it to the sinusoids of the
liver.
• After a meal, hepatic portal blood is rich in nutrients absorbed
from the GIT.
• Liver stores some of them and modifies others and detoxify
before they pass into the general circulation

Cont’d…
• Superior mesenteric and splenic veins unite to form the
hepatic portal vein.
• SMV drains blood from the small intestine and portions of the
large intestine, stomach, and pancreas through the jejunal,
ileal, ileocolic, right colic, middle colic, pancreaticoduodenal,
and right gastroepiploic veins.
• Splenic vein drains blood from the stomach, pancreas, and
portions of the large intestine through short gastric, left
gastroepiploic, pancreatic, and inferior mesenteric veins.

Cont’d…
• Inferior mesenteric vein — which passes into the splenic vein,
drains portions of the large intestine through the superior
rectal, sigmoidal, and left colic veins.
• Right and left gastric veins(coronary vein), which open directly
into the hepatic portal vein, drain the stomach.
• Cystic vein, which also opens into the hepatic portal vein,
drains the gall bladder.

Cont’d…
• At the same time the liver is receiving nutrient rich but
deoxygenated blood via the hepatic portal vein, it also is
receiving oxygenated blood via the hepatic artery.
• Oxygenated blood mixes with the deoxygenated blood in
sinusoids.
• Blood leaves the sinusoids of the liver through the hepatic
veins, which drain into the IVC.

Pulmonary circulation:
• Carries deoxygenated blood from the right ventricle to
alveolar capillaries and returns oxygenated blood to the left
atrium.
• Pulmonary trunk emerges from the right ventricle and passes
superiorly, posteriorly, and to the left.
• Then divides into 2 branches: right pulmonary artery to the
right lung and the left pulmonary artery to the left lung.
• After birth, pulmonary arteries are the only arteries that carry
deoxygenated blood.

Cont’d…
• On entering the lungs, the branches divide and subdivide until
finally they form capillaries around the air sacs within the
lungs.
• Pulmonary capillaries unite to form venules and eventually
pulmonary veins, which exit the lungs and carry the
oxygenated blood to the left atrium.
• 2 left and 2 right pulmonary veins enter the left atrium.
• After birth, the pul. Veins are the only veins that carry
oxygenated blood.

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