Venous and
Lymphatic drainage
of Lower limb
Dr Shivram Bhat P
Learning objectives
• To learn the origin, termination, course,
tributaries and applied anatomy of veins of
lower limb.
• To learn about the different groups of
lymphnodes and their applied anatomy.
Veins of the lower limb
• Divided in to two groups
• Superficial veins
• Deep veins
Venous drainage of lower limb
• Superficial veins – are in the subcutaneous tissue
• They have thicker wall compared to other superficial
veins
• Not accompanied by any arteries
• Have many valves
• These break the venous column into shorter segments
• They are connected to the deep veins by many
perforating veins
Venous drainage of lower limb
• Deep veins – lie deep to the deep fascia, enclosed in a
tight sleeve of deep fascia
• Accompany the arteries – venae comitantes
• They occur as paired, frequently interconnecting veins
that flank the accompanying artery
• The pulsation of these arteries compress the vein and
help in the movement of venous blood
Veins of the lower limb
• Superficial:
• Great (long) saphenous
vein
• Short (small) saphenous
vein
• Many tributaries of the
above veins
• Deep veins: accompany
arteries
• Anterior tibial
• Posterior tibial
• Popliteal
• Femoral
• Plantar arch and its
tributaries
Great saphenous vein
Formation – by the joining of
medial side of the dorsal venous
arch with medial dorsal digital
vein of great toe
Course: it runs upwards and
backwards anterior to the
medial malleolus
Runs on the medial surface of
the distal third of tibia
Great saphenous vein
Ascends on the medial border of tibia
to the posteromedial surface of knee.
Further, inclines anteriorly on to the
front of the thigh
Terminates in the femoral vein in the
femoral triangle after passing through
the saphenous opening
It is accompanied by saphenous nerve
in the leg and the medial cutaneous
nerve in the thigh
Great saphenous vein
Tributaries:
Lateral and anterior
cutaneous veins of thigh
Anterior cutaneous vein
of leg
Accessory
saphenous vein
Great saphenous vein - tributaries
Before termination –
three superficial veins
Superficial epigastric
vein
Superficial circumflex
iliac vein
Superficial external
pudendal vein
Short saphenous vein
Arises on the lateral side of
the foot by the joining of the
lateral side of the dorsal
venous arch with the lateral
digital vein of little toe
Ascends behind the lateral
malleolus
Passes along the lateral
border of calcaneal tendon
Short saphenous vein
Inclines to the midline of the leg
and pierces the deep fascia
Ascends between the two
heads of the gastrocnemius
muscle
Ends in the popliteal vein in the
popliteal fossa
Is accompanied by the sural
nerve
Perforating veins/perforators
Connect superficial veins with deep
veins
They pierce the deep fascia obliquely
Contain valves that allow flow of
blood from superficial veins to
deep veins
Perforating veins/perforators
Perforating veins/perforators
• Flow from superficial to deep veins is important
for venous return from lower limbs.
• It enables the muscular contractions to propel
the venous blood to heart against the pull of
gravity
• This is referred as musculovenous pump
Perforating veins/perforators
• The outward expansion of the muscles during
contraction is limited in the lower limb due to
thick deep fascia
• This compresses the veins, ‘milking’ the blood
superiorly towards the heart – this is called
musculovenous pump
Perforating veins/perforators
• When muscles contract
and the pressure
increases inside the deep
fascia, the perforating
veins also get
compressed.
• This prevents the blood
from flowing from deep to
superficial veins
Perforating veins/perforators
The valves of the veins
break up the columns
of blood
This relives excess
pressure on the distal
(more dependent)
segment of the vein
and allows the venous
blood to flow only
towards the heart
Deep veins
Anterior tibial vein:
Veins accompanying dorsal
metatarsal arteries end in the
dorsal venous arch (arcuate
artery)
Venous arch continues as the
anterior tibial vein
Finally joins with the posterior
tibial vein to form popliteal vein
Deep veins
Posterior tibial vein:
Plantar metatarsal veins join
to for plantar arch (continues
as lateral plantar vein)
This will join the medial
plantar vein and continue as
posterior tibial vein
This vein is joined by the
peroneal or fibular vein
Deep veins
Posterior tibial vein
combines with the
anterior tibial vein and
continues as popliteal
vein
These veins receive
many tributaries
corresponding to the
branches of the
arteries of same name
Femoral vein
Continuation of the
popliteal vein
Receives profunda
femoris vein and its
tributaries
Many muscular veins form
other tributaries of this
vein
Continues as external iliac
vein
Applied aspects
• Varicose veins: frequently
the great saphenous vein
and its tributaries become
dilated and tortuousvaricose veins.
• Venous reflux disease
• Common on the
posteromedial parts of the
lower limb
Applied aspects
Causes:
Valves of the
perforators becoming
incompetent
Valves of the
superficial veins itself
are incompetent
Applied aspects
• Varicose veins : occurs
both in men and women
• Affects most commonly
women of childbearing
years and older people
• Family history of varicose
vein
Varicose veins
• Common among persons
standing for long
durations
• Pregnant women
• Sedentary habit
• Weight gain
Varicose veins
Symptoms: Aching, cramps, itching, swelling and fatigue
Applied aspects
• Venous thrombosis: blood clot formation e.g.
bone fracture
• Venous stasis (stagnation) is another cause of
clot formation.
• Stasis occurs due to:
• Incompetent deep fascia that fails to resist
muscle expansion, diminishing the effectiveness
of musculovenous pump
Applied aspects
• External pressure on the veins from the bedding
during prolonged hospitalisation or from tight
cast or bandage
• Muscular inactivity – during an overseas flight
Applied aspects
• Thrombophlebitis: inflammation with clot
formation may develop around vein
• A thrombus can break free from lower limb vein
and reach the lungs, constitutes pulmonary
thromboembolism.
• A large embolus may obstruct the pulmonary
artery and cause death.
Applied aspects
• Saphenous venous graft: commonly used for
coronary artery bypass surgery
• Reasons: easily accessible
• Sufficient length between a tributary and
perforating vein so that a usable length can be
harvested
Applied aspects
• Wall contains higher percentage of muscle and
elastic fibers
• When part of vein is used for bypass the vein is
reversed so that valves do not obstruct the flow
of blood in the graft
• Long saphenous vein is useful in emergency
transfusion
Investigations
• Venography – function of the vein and
their valves
• Doppler ultrasound – useful to study the
flow of blood and patency of the vein
Spider veins
Appear close to
surface
Short, fine lines
Web like maze
Common in the
thighs, ankles and
feet
Lymph Nodes of Lower Limb
• Nodes – inguinal and popliteal.
• Inguinal – superficial and deep group.
Popliteal nodes
Lymphatic vessels
Applied anatomy
• Lymphangitis.
• Filariasis.
• Lymphoedema.
Lymphangitis
Questions
• Great saphenous vein.
• Inguinal lymph nodes.
• Varicose veins.