Veins of the lower extremity (Figure 35–1)
consist of superficial and deep systems joined by venous perforators.
The greater and lesser saphenous veins are superficial—veins,
the name “saphenous” aptly derived from the Greek
word for “manifest, clear,” or “visible.” They contain
many valves and show considerable variation in their location and branching
points. The greater saphenous vein may be duplicated in up to 10% of patients.
Typically, it originates from the superficial arch of the foot and
is found anterior to the medial malleolus at the ankle. As it ascends
in the calf just beneath the superficial fascia, it is joined by
two major tributaries: an anterior vein, which crosses the tibia;
and a posterior arch vein, which arises posterior to the medial
malleolus beside the posterior tibial artery. The greater saphenous
vein then enters the fossa ovalis in the groin to empty into the
deep femoral vein.
Anatomy of the superficial and perforating veins of the
lower extremity. (From Rutherford RB, Cronenwett JL, Gloviczki
P: Vascular Surgery. Philadelphia: Saunders, 2000.
Reproduced by permission from Elsevier.)
The saphenofemoral junction is marked by four or five prominent
branches of the greater saphenous vein: the superficial circumflex
iliac vein, the external pudendal vein, the superficial epigastric
vein, and the medial and lateral accessory saphenous veins. Another
important anatomic landmark is the relationship of the greater saphenous
vein to the saphenous branch of the femoral nerve; as it emerges
from the popliteal space, the nerve follows a course parallel to
the vein. Injury during saphenous vein stripping or saphenous vein
harvest for bypass produces neuropathic pain or numbness along the
medial calf and foot. The lesser saphenous vein arises from the
superficial dorsal venous arch behind the lateral malleolus at the
ankle and curves toward the midline of the posterior calf, ascending
to join the popliteal vein behind the knee.
Deep veins of the leg parallel the courses of the arteries. Two
or three venae comitantes accompany each tibial artery. At the knee,
these paired high-capacitance veins merge to form the popliteal
vein, which continues proximally as the femoral vein. At the inguinal
ligament, the femoral and deep (profunda) femoral veins join medial
to the femoral artery to form the common femoral vein. Proximal to
the inguinal ligament, the common femoral vein becomes the external
iliac vein. In the pelvis, external and internal iliac veins join
to form common iliac veins that empty into the inferior vena cava (IVC).
The right common iliac vein ascends almost vertically to the IVC while
the left common iliac vein takes a more transverse course. For this
reason, the left common iliac vein may be compressed between the
right common iliac artery and lumbosacral spine, a condition known
as May-Thurner (Cockett) syndrome when thrombosis of the left iliac vein