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Major Veins of the Body Important

Doctors Notes
Notes/Extra explanation
Please view our Editing File before studying this lecture to check for any changes.
 Objectives
At the end of the lecture, the student should be able to:
ü Define veins and understand the general principle of venous system.
ü Describe the superior & inferior Vena Cava: formation and their tributaries
ü List major veins and their tributaries in:
• head & neck
• thorax & abdomen
• upper & lower limbs
ü Describe the Portal Vein: formation & tributaries.
ü Describe the Portocaval Anastomosis: formation, sites and importance
 Veins
o Veins are blood vessels that bring blood back to the heart.
o All veins carry deoxygenated blood except:
o Pulmonary veins1.
o Umbilical veins2.
o There are two types of veins*:
1. Superficial veins: close to the surface of the body
NO corresponding arteries *Note:
2. Deep veins: found deeper in the body Vein can be classified in 2
With corresponding arteries (venae comitantes) ways based on:
o Veins of the systemic circulation: (1) Their location
Superior and inferior vena cava with their tributaries (superficial/deep)
(2) The circulation
o Veins of the portal circulation:
(systemic/portal)
Portal vein

1: are large veins that receive oxygenated blood from the lung and drain into the left atrium.
2: The umbilical vein is a vein present during fetal development that carries oxygenated blood from the
placenta into the growing fetus.
 Only on the boys’ slides

The Histology Of Blood Vessels

o The arteries and veins have three layers, but the middle
layer is thicker in the arteries than it is in the veins:

1. Tunica Intima (the thinnest layer): a single layer of

simple squamous endothelial cells.
2. Tunica Media (the thickest layer in arteries): is made
up of smooth muscle cells and elastic tissue.
3. Tunica Adventitia: (the thickest layer in veins) entirely
made of connective tissue.

o Capillaries consist of little more than a layer

of endothelium and occasional connective tissue.
Superior Vena Cava
o Formed by the union of the right and left brachiocephalic
veins.
• Brachiocephalic veins are formed by the union of
internal jugular and subclavian veins.

o Drains venous blood from:

Head, neck, thoracic wall & upper limbs.

o It Passes downward and enter the right atrium.

o Receives azygos vein on the posterior aspect just before

it enters the heart.

Sup
 Veins Of Head &
Neck

Superficial Deep

External Anterior Internal

Jugular Vein Jugular Vein Jugular Vein

Note:
Union: when to veins join together they give rise to a vein with a new name.
Tributary: when one vein drains into another, but no new vein is produced.
Jugular means of the neck.
Veins of Head and Neck
External Jugular Vein
o Lies superficial to the sternomastoid (sternocleidomastoid)
muscle .
o It passes down the neck and it is the only tributary of the
subclavian vein.
o Begins just behind angle of mandible by union of:
a. the posterior division of the retromandibular vein
(temporomaxillary vein)
b. with the posterior auricular vein.
o It drains blood from:
a. Outside of the skull
b. Deep parts of the face.
Tributaries:
• Posterior external jugular vein.
• Anterior jugular vein.
• Suprascapular vein.
• Transverse cervical vein.
To remember: PAST
 Veins of Head and Neck
Anterior Jugular Vein
o It begins in the upper part of the neck by the union of the submental
veins (small veins found in an area known as the submental triangle).

o It descends close to the median line of the neck, medial to the

sternomastoid muscle.

o At the lower part of the neck, it passes laterally beneath (deep to)
sternomastoid to drain into the external jugular vein.

o Just above the sternum the two anterior jugular veins communicate
by a transverse vein to form the jugular arch.

Extra
Veins of Face and Neck
Internal Jugular Veins
o Drains blood from the head, brain, face & neck.
o It descends in the neck along with the internal and common carotid
arteries and vagus nerve, within the carotid sheath.
o Joins the subclavian vein to form the brachiocephalic vein.
o Tributaries:
• Superior thyroid
• Lingual (in the tongue)
• Facial
• Occipital veins
• Pharyngeal veins
• Dural venous sinuses (Inferior petrosal sinus)
Note:
• the occipital vein’s drainage can vary.
• Dural venous sinuses: these are venous sinuses found between the
periosteal and meningeal layer of the dura matter (check next slide).
• The inferior part of the internal jugular vein has a dilation known as
the inferior bulb. Above the bulb there is a valve.
Extra pictures for understanding
 Veins Of Upper Limbs
1- Superficial Veins
A- Cephalic Vein
o Ascends in the superficial fascia on the lateral side of the biceps.
o Drains into the Axillary vein.
B- Basilic Vein
o Ascends in the superficial fascia on the medial side of the biceps.
o Halfway up the arm, it pierces the deep fascia
o At the lower border of the teres major it joins the venae comitantes of
the brachial artery to form the Axillary vein.
2- Deep Veins
A- Venae Commitantes
o Which accompany all the large arteries and are usually in pairs.
B- Axillary Vein
o Formed by the union of basilic vein and the venae comitantes (brachial
veins) of the brachial artery.
Inferior Vena Cava
o Drains most of the blood from the body below the
diaphragm to the right atrium.

o Formed by the union of the two common iliac veins

behind the right common iliac artery at the level of
the 5th lumbar vertebra.

o Ascends on the right side of the aorta

o Pierces the central tendon of diaphragm at the level

of the 8th thoracic vertebra*.
*Recall the descending aorta pierced the diaphragm at T12.
To remember:
Mnemonic of major openings of diaphragm: I ate (8) 10 Eggs At 12.
(I 8= inferior vena cava pierce at T8,
10 Eggs= Esophagus pierces at T10 ,
At 12 = Aorta pierces at T12)
Inferior Vena Cava (Tributaries)
From bottom to top ↑
1. Median sacral vein
2. Two common iliac veins
3. Four paired lumbar veins
4. Right gonadal vein (the left vein drains into the left renal vein*)
5. Paired renal veins
6. Right suprarenal vein (the left vein drains into the left renal vein*)
7. Hepatic veins
8. Paired inferior phrenic vein

*Note:
The left gonadal/suprarenal veins drain into the IVC but
INDIRECTLY. They first drain into the left renal vein which
then drains into the IVC. That’s why we didn’t list them here
Median sacral vein
as part of the tributaries.
Veins Of Lower Limbs

TWO DIVISIONS:

SUPERFICIAL VEINS DEEP VEINS

Form a network in
They are the
the subcutaneous Pattern is variable
tributaries of the:
tissue

Great (long) Small (short)

saphenous vein saphenous vein
Veins Of Lower Limbs
Great Saphenous Vein
o The longest vein.
o Beginning:
from the medial end of the dorsal venous arch of the foot.

Ascending :
Then it ascends in
Passes upward in front Ascends obliquely Passes behind the knee
accompany with the
of the medial malleolus upwards, and lies and curves forward
(constant position) with
saphenous nerve in the behind the medial around the medial side
the saphenous nerve. superficial fascia over border of the patella. of the thigh.
the medial side of the leg

o Termination :
Hooks through the lower part of the saphenous opening in the deep
fascia to join the femoral vein about 1.5 inch (4 cm) below and lateral
to the pubic tubercle.
Veins Of Lower Limbs
Great Saphenous Vein
o It is connected to the small saphenous vein by one or two branches
that pass behind the knee.
o Numerous perforating veins connect the great saphenous vein with
the deep veins (femoral vein).
o The perforating veins have valves which allow blood flow from
superficial to deep veins.

o The great saphenous vein is used in venous grafting (‫ )اﻟﺗطﻌﯾم‬

and saphenous vein cutdown may be necessary for inserting
the needle or canula (take care of the saphenous nerve)
Only on the girls’ slides
Veins Of Lower Limbs
Small Saphenous Vein
o Beginning:
from the lateral end of the dorsal venous arch of the foot.
o Has numerous valves along its course.
o Anastomosis freely with great saphenous vein.

Ascending :

Follows the lateral border of

Ascends behind the lateral Pierces the deep fascia in the
the tendocalcaneus and then
malleolus in company with the lower part of the popliteal
runs up to the middle of the
sural nerve. fossa
back of the leg.

o Termination:
Drains into the popliteal vein .
Doctor’s note: the small saphenous vein join the venae
comitantes and forms the popliteal vein.
Veins Of Lower Limbs
Deep Veins
o Comprise the venae comitantes, which accompany all
the large arteries, usually in pairs.

o Venae comitantes unite to form the popliteal vein,

which continues as the femoral vein.

o Receive blood from superficial veins through

perforating veins.
Mechanism Of Venous Return From Lower Limb (For Your Information)
o Much of the saphenous blood passes from superficial to deep veins
through the perforating veins
o The blood is pumped upwards in the deep veins by the contraction of
the calf muscles (calf pump).
o This action of calf pump is assisted by the tight sleeve of deep fascia
surrounding these muscles.

Varicose Veins
o If the valves in the perforating veins become
incompetent, the direction of blood flow is reversed
and the veins become varicosed.

o Most common in posterior & medial parts of the

lower limb, particularly in old people.
 Only on the boys’ slides

Factors Aiming Blood Return

o Muscle Contraction.
Rhythmical contraction of limb muscles as occurs during normal locomotory
activity (walking, running, swimming) promotes venous return by the muscle
pump mechanism.

o Respiratory Pump
During respiratory inspiration, the venous return increases because of a
decrease in right atrial pressure.

o Decreased Venous Compliance

Sympathetic activation of veins decreases venous compliance, increases central
venous pressure and promotes venous return.

o Gravity
The effects of gravity on venous return seem paradoxical because when a person
stands up hydrostatic forces cause the right atrial pressure to decrease and the
venous pressure in the dependent limbs to increase
 Portal Circulation
o A portal venous system is a series of veins or
venules that directly connect two capillary beds.

o Examples of such systems include the hepatic

portal vein and hypophseal portal system.
Portal Circulation
Hepatic Portal Vein
o Drains blood from the gastrointestinal tract and
spleen to the liver.
o It is formed by the union of the superior mesenteric
and splenic veins behind the neck of pancreas.
o Immediately before reaching the liver, the portal vein splenic
divides into right and left that enter the liver.
o Tributaries:
• Right and Left Gastric veins.
• Cystic vein from the gall bladder joins its right
branch.
• Para-umbilical veins that drain veins from anterior
abdominal wall to the hepatic portal vein.
 Portal Circulation
Portocaval Anastomosis
o A portacaval anastomosis (also known as portal systemic
anastomosis) is a specific type of anastomosis that occurs
between the veins of portal circulation and those of
systemic circulation.
o The anastomotic channels become dilated (varicosed) in
case of portal hypertension.
Portal Circulation
Sites Of Portocaval Anastomosis
Portocaval Anastomosis
Site Associated condition
Portal Vein Systemic Vein
Esophageal branch of
Lower end of esophagus Left gastric vein Esophageal Varices
azygos vein
Lower part of rectum (or Superior rectal Middle and inferior
Hemorrhoids
upper part of anal canal) vein rectal vein
Para umbilical Superficial epigastric
Para umbilical regoin Caput Medusae
veins vein
Veins of the posterior
Retroperitoneal Colic veins abdominal wall --
(retroperitoneal veins)
Patent ductus venosus Umbilical vein +
Inferior Vena Cava --
(intrahepatic) portal vein
There is some anastomosis between portal venous channels in
Bare area of liver
the liver and azygous system of veins above the diaphragm.
 MCQs
Which of the following is the thickest layer in the artery ? Which one of the following nerves accompany the great saphenous vein in
the medial side of the leg ?
A. Tunica Media.
A. Sural nerve
B. Tunica Intima.
B. Sciatic nerve
C. Tunica Adventitia.
C. Saphenous nerve
Answer: A
D. Tibial nerve
Answer: C
Which of the following veins is the only tributary of the subclavian vein?
A. External jugular vein
Which one of the following veins can be used in coronary artery bypass ?
B. Internal jugular vein
a. Small saphenous vein
C. Anterior jugular vein
b. Hepatic veins
D. Occipital vein
c. Renal veins
Answer: A
d. Great saphenous vein

which of the following is a tributary for the internal jugular vein? Answer: D

A. anterior jugular vein

The anastomotic channels of portocaval become dilated (varicosed) in
B. Transverse cervical vein case of.. ?
C. facial vein A. portal hypertension
D. Suprascapular vein B. portal hypotension
Answer: C C. none of A&B
D. both of A&B
Answer : A
Leaders: Members:
Nawaf AlKhudairy Yazeed Alsuhaibani
Jawaher Abanumy Abdulmalek Alhadlaq
Hamad Alkhudairy
Mohammed Habib
Talal Alhuqail
Majed Alzain
[email protected]
Mohammed naser
Abdulaziz Alsalman
@anatomy436
Abdulhakeem Alonaiq