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Lower Extremity Venous Anatomy

Arteries convey oxygen-rich blood from the heart to the feet. Veins return depleted blood from the feet back to the heart. The lower extremity venous anatomy is divided into three systems: the deep venous system, superficial venous system, and the perforator veins.

The deep system consists of the common femoral vein, the femoral vein (formerly known as the superficial femoral vein), the deep femoral vein, the popliteal vein and the deep veins of the calf. The deep veins are located near the center of the legs and are surrounded by muscles and fascia. Deep veins are well-supported and naturally resistant to dilation and valvular failure. Most vein patients therefore have normal deep veins. This is fortunate because the deep venous system is responsible for 90% of lower extremity blood return.

The main superficial veins are the great saphenous and small saphenous veins. Accessory saphenous veins, the intersaphenous vein (a.k.a. Vein of Giacomini), and various tributaries drain into the great saphenous and small saphenous veins. The superficial veins reside just below the skin and are not effectively supported by muscle or fascia. They are therefore prone to dilation and valvular failure. Most venous insufficiency occurs in the superficial venous system.

Each leg has over 150 perforator veins that connect the deep and superficial venous systems. Perforator veins contain valves that normally direct blood from the superficial veins to the deep veins. If these valves fail, high-pressure deep venous blood refluxes into the superficial veins, causing severe superficial venous hypertension. Perforator vein disease is a common cause of superficial venous insufficiency and venous stasis ulcers.

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