Veins of the lower limb

Great saphenous vein

The great saphenous vein is also referred to as the long saphenous vein and is the longest vein in the human body. It is a continuation of the medial marginal vein of the foot and ends in the femoral vein, distal to the inguinal ligament.

It ascends superficial to the medial malleolus, before crossing the distal third of the tibia anteroposteriorly. It passes behind the medial tibial and femoral condyles before ascending up the medial aspect of the thigh and passing through the saphenous opening, an aperture in the fascia lata of the thigh. It opens into the femoral vein 2.5 – 3.5 cm inferolateral to the pubic tubercle. The great saphenous vein is accompanied by branches of the medial femoral cutaneous nerve throughout its course in the thigh. It contains 10-20 venous valves, which are more numerous within the leg.

The great saphenous vein has many connections with the small saphenous vein and the deep veins of the lower limb via perforating veins. Just distal to the knee, the great saphenous vein communicates and receives blood from the small saphenous vein, anterior and posterior tibial veins. The main tributaries of the great saphenous vein join it in the thigh, near its junction with the femoral vein. There are six of such tributaries: 

1. Posteromedial vein of the thigh (accessory vein of the thigh) - drains the superficial aspect of the posteromedial region of the thigh
2. Anterior femoral cutaneous vein - a continuation of anterior veins in the distal thigh; it crosses the femoral triangle before opening into the great saphenous vein
3. Superficial epigastric vein - drains the inferior abdominal wall and opens into the great saphenous vein as it traverses the saphenous opening
4. Superficial circumflex iliac vein - also drains the inferior abdominal wall and opens into the great saphenous vein as it passes through the saphenous opening
5. Superficial external pudendal vein - drains part of the scrotum or labia, and also opens into thegreat saphenous vein at the saphenous opening
6. Deep external pudendal vein - also joins the great saphenous vein at the saphenous opening

Flashcards would be the perfect way to revise all of these veins. Find out how you can make your own!

Small saphenous vein

The small saphenous vein, also referred to as the short saphenous vein, is a continuation of the lateral marginal vein. It passes lateral to the calcaneal tendon and ascends between the superficial and deep fascia in the distal third of the calf. At the midline of the calf, it penetrates the deep fascia before ascending superficial to the gastrocnemius muscle.

At the junction of the intermediate and proximal thirds of the calf, the small saphenous vein emerges above the deep fascia before passing between the heads of the gastrocnemius muscle. It terminates in the popliteal vein within the popliteal fossa, 3- 7.5 cm above the knee joint.

The small saphenous vein has 7-13 valves and lies near the sural nerve within the leg. On the dorsum of the foot, deep veins drain into the small saphenous vein and within the leg, it receives many cutaneous tributaries. It has many branches, which communicate with the great saphenous vein.

If you want to visualize the veins and understand them even better, take advantage of the videos, illustrations and quizzes included in the following study unist:

Veins of the foot

The foot consists of two main types of deep veins:

• Plantar veins, which drain the plantar surface or underside of the foot
• Dorsal veins, which drain the dorsal or upper surface of the foot

Venous plexuses within the plantar regions of the toes join to form plantar digital veins. These veins connect with their dorsal counterparts, the dorsal digital veins, to form four plantar metatarsal veins. These veins run proximally within the intermetatarsal spaces and then continue on to form the deep plantar venous arch. Medial and lateral plantar veins arise from this arch.

A dorsal venous arch is also present and is formed by the dorsal metatarsal veins, which are also formed by the dorsal and plantar digital veins.

Veins of the leg

The anterior tibial veins are formed by the venae comitantes, or companion veins, of the dorsalis pedis artery.

The posterior tibial veins are formed by the medial and lateral plantar veins and accompany the posterior tibial artery. Veins from the calf muscles drain into posterior tibial veins. They also receive connections from the superficial veins and the fibular veins.

The fibular veins are also formed by the medial and lateral plantar veins and run with the fibular artery. They receive tributaries from superficial veins and veins draining the soleus muscle.

Vein of the knee

The popliteal vein is located within the popliteal fossa and pierces the adductor magnus muscle, where it becomes the femoral vein. Distally it is medial to the popliteal artery. Between the two heads of the gastrocnemius muscle it is superficial to it and proximally it is posterolateral to it.

The popliteal vein usually has 4 or 5 valves and many tributaries. All of the three main veins of the leg drain into it, as well as the small saphenous vein and two muscular veins from each head of the gastrocnemius muscle.

Veins of the thigh

The femoral vein is a continuation of the popliteal vein and accompanies the femoral artery. It begins at the opening of the adductor magnus muscle and ends posterior to the inguinal ligament as the external iliac vein.

Its relationship to the femoral artery is variable. Within the distal adductor canal, it is located posterolateral to the artery, whilst in the proximal canal and in the apex of the femoral triangle, it lies posterior to the artery. Within the base of the femoral triangle, it is found medial to the femoral artery. It is contained within the middle compartment of the femoral sheath and usually has four or five valves.

Tributaries of the femoral vein include:

• the medial circumflex vein
• lateral circumflex vein
• great saphenous vein
• profunda femoris vein, which drains 4-12 cm distal to the inguinal ligament.

The profunda femoris vein, also referred to as the deep vein of the thigh, is located superficial to the profunda femoris artery. Veins accompanying the perforating branches of the profunda femoris artery drain the thigh muscles and empty into the profunda femoris vein. The medial and lateral circumflex veins are sometimes tributaries of the profunda femoris vein.