Venous Anatomy of Lower Limb

Veins of lower limb classified into three groups:

1. Superficial

Two major systems: tributaries and main trunks of long and short saphenous veins
Long: begins on dorsum of foot and runs anterior to medial malleolus, along medial aspect of calf and thigh
Ends in saphenofemoral jx --> enters common femoral vein
- this point is 2-3c, blow and lateral to the pubic tubercle.
A major tributary, the posterior arch vein joins the long saphenous just below the knee
- drains much of medial calf
- communicates with deep venous plexus of calf by several perforators (perforate deep fascia)
In thigh, there are large medial and lateral tributaries and thigh perforating veins
- and more tributaries join the long saphenous close to its termination.
Short saphenous begins behind the lateral malleolus of the ankle and runs along the lateral and then posterior spect of the calf
- penetrates deep fascia in upper calf
--> joins popliteal vein at the level of the knee crease.

2. Deep

Deep veins run as venae comtantes of the major arteries in foot and calf
- including venous sinusoids in the calf muscle
Receives perforating veins from the superficial system.
Join to form a single popliteal vein at about the level of the knee.
Runs proximally with main artery to become femoral then external iliac under the inguinal ligament.

3. Perforating.
Join superficial and deep systems
Contain valves, directing flow from superficial to deep
Variable in number and position
Usual sites are medial side of lower third of calf, between posterior arch vein and posterior tibial veins
At about jx of middle and lower thirds of thigh.
Others join the anterior tibial, peroneal and superficial veins

Nerves
SSV related to sural nerve
GSV related to saphenous nerve (much closer below the knee).
Inconsistency makes precise localisation difficult, important reason for recurrent disease.