Veins of the upper limb.

Superficial (subcutaneous) and deep veins of the arm The veins of the upper limb are divided into deep and superficial. The superficial, or subcutaneous, veins, anastomosing between themselves, form a wide-celled network, from which it is more isolated in places. large trunks. These trunks are as follows:

1. V. cephalica, lateral saphenous vein of the arm, begins in the radial region of the hand rear, on the radial side of the forearm reaches the elbow, anastomosing here with v. basilica, goes along sulcus bicipitalis lateralis, then pierces the fascia and flows into v. axillaris

2. V. basilica, medial saphenous vein of the arm, begins on the ulnar side of the back of the hand, and is sent to the medial part of the anterior surface of the forearm along m. flexor carpi ulnaris to the elbow, anastomizing here with v. cephalica through v. intermedia cubiti; then it lies in the sulcus bicipitalis medialis, pierced the fascia halfway through the shoulder and poured into the v. brachialis.

3. V. intermedia cubiti, intermediate vein of the elbow, is an obliquely located anastomosis connecting the elbow region to each other v. basilica and v. cephalica. It usually falls into v. intermedia antebrachii, which carries blood from the palmar side of the hand and forearm. V. intermedia cubiti is of great practical importance, as it serves as a place for intravenous infusions of medicinal substances, blood transfusion and taking it for laboratory research.

Deep veins accompany the arteries of the same name, usually two each. Thus, there are two vv. brachiales, ulnares, radiales, interosseae.

Both vv. brachiales at the bottom edge m. pectoralis major, fuse together and form the axillary vein, v. axillaris, which lies in the armpit medially and anterior to the artery of the same name, partly covering it. Passing under the clavicle, it continues further in the form of v. subclavia.

In v. axillaris, except for the above v. cephalica, flows into v. thoracoacromialis (corresponding to the artery of the same name), v. thoracica lateralis (into which v. thoracoepigastrica, the large trunk of the abdominal wall often falls), v. subscapularis, vv. circumflexae humeri.

Anterior jugular vein

V. jugularis anterior, the anterior jugular vein, is formed from small veins above the hyoid bone, from which it descends vertically downwards. Both v. The jugulares anteriores, right and left, pierce a deep leaf of fascia colli propria, enter the spatium interaponeuroticum suprasternal and infuse the subclavian vein. In the nadprudinnom gap both vv. jugulares anteriores anastomose among themselves with one or two trunks. Thus, a venous arch, the so-called arcus venbsus juguli, forms above the upper edge of the sternum and the clavicle. In some cases, w. jugulares anteriores are replaced by one unpaired v. jugularis anterior, which descends along the midline and below, merges into the said venous arch, which in such cases forms from the anastomosis between the vv. jugulares externae.

Internal jugular vein. Tributaries of the internal jugular vein

V. jugularis interna, internal jugular vein, carries blood from the cranial cavity and organs of the neck; beginning in foramen jugulare, in which it forms an expansion, bulbus superior venae jugularis internae, the vein descends, lying lateral to a. carotis interna, and further down laterally from a. carotis communis. At the lower end of v. jugularis internae before connecting it with v. subclavia forms a second thickening – bulbus inferior v. jugularis internae; in the neck area above this bulge in the vein there is one or two valves. On its way to the neck, the internal jugular vein is covered by m. sternocleidomastoideus and m. omohyoideus.

Tributaries of the internal jugular vein are divided into intracranial and extracranial. The first are the sinuses of the dura mater of the brain, sinus durae matris, and the cerebral veins flowing into them ,, v. cerebri, veins of the cranial bones, vv. diploicae, veins of organ of hearing, vv. auditivae, orbital veins, v. ophtalmicae, and hard-shell veins, vv. meningeae. The latter include the veins of the external surface of the skull and the face, which flow into the internal jugular vein along its course.

There are connections between the intracranial and extracranial veins through so-called graduates, vv. emissariae passing through the corresponding openings in the cranial bones (foramen parietale, foramen mastoideum, canalis condylaris).

1. V. facialis, facial vein. Its tributaries correspond to ramifications a. facialis and carry blood from various face formations.

2. V. retromandibularis, mandibular vein, collects blood from the temporal region. Further down in v. retromandibularis flows into the trunk, carrying blood from the plexus pterygoideus (dense plexus between mm. pterygoidei), followed by v. Retromandibularis, passing through the thickness of the parotid gland together with the external carotid artery, below the angle of the mandible merges with v. facialis.

The shortest path connecting the facial vein with the pterygo plexus is the anatomical vein (v. Anastomotica facialis), which is located at the level of the alveolar margin of the mandible.

By combining the superficial and deep veins of the face, the anastomotic vein can become a way of spreading the infectious principle and therefore has practical significance.

There are also anastomoses of the facial vein with the orbital veins.

Thus, there are anastomotic connections between the intracranial and extracranial veins, as well as between the deep and superficial veins of the face. As a result, the multi-tiered venous system of the head and the connection between its various divisions are formed.

3. Vv. pharyngeae, pharyngeal veins, forming a plexus (plexus pharygneus) on the pharynx, infuse or directly into v. jugularis interna, or fall into v. facialis.

4. V. lingualis, the lingual vein, accompanies the artery of the same name.

5. Vv. thyroideae superiores, the superior thyroid veins, collect blood from the upper portions of the thyroid gland and the larynx.

6. V. thyroidea media, the middle thyroid vein, moves away from the lateral margin of the thyroid gland and merges into v. jugularis interna. At the lower edge of the thyroid gland there is an unpaired venous plexus, plexus thyroideus impar, outflow from which occurs through the vv. thyroideae superiores in v. jugularis interna, as well as v. thyroideae interiores and v. thyroidea ima in the veins of the anterior mediastinum.

Shoulder veins

Vv. brachiocephalicae dextra et sinistra, brachiocephalic veins, which form the superior vena cava, are in turn obtained by each fusion v. subclaviae and v. jugularis internae. The right brachiocephalic vein is shorter than the left, only 2–3 cm long having formed behind the right sternoclavicular joint, it goes obliquely downwards and medially to the confluence with the same vein of the left side. Front right brachial head vein covered by mm. sternocleidomastoideus, sternohyoideus and sternothyroideus, and below – cartilage I ribs. The left brachiocephalus is approximately twice as long as the right. Formed behind the left sternoclavicular joint, it goes behind the sternum handle, separated from it only by the fiber and thymus gland, right and down, to the confluence with the right brachiocephalic vein; closely adjoining at the same time with its lower wall to the bulge of the aortic arch, it crosses in front of the left subclavian artery and the initial parts of the left common carotid artery and brachiocephalic trunk. In the brachiocephalic veins fall vv. thyroideae inferiores and v. thyroidea ima, formed from the dense venous plexus at the lower edge of the thyroid gland, thymus vein, vv. vertebrates, cervicales et thoracicae internae.

Veins of a large circle of blood circulation.

The system of the superior vena cava, the superior vena cava, is a thick (about 2.5 cm) but short (5–6 cm) trunk, located on the right and somewhat behind the ascending aorta.

The superior vena cava is formed from the confluence vv. brachiocephalicae dextra et sinistra behind the junction I of the right rib to the sternum. From here it goes down along the right edge of the sternum behind the first and second intercostal spaces and at the level of the upper edge of the third rib, hiding behind the right ear of the heart, flows into the right atrium.

Its back wall is in contact with a. pulmonalis dextra, which separates it from the right bronchus, and for a very short distance, at the site of the confluence with the atrium, with the upper right pulmonary vein; both of these vessels cross it transversely.

At the level of the upper edge of the right pulmonary artery, v. Flows into the superior vena cava. azygos, bending over the root of the right lung (the aorta bends over the root of the left lung). The anterior wall of the superior vena cava is separated from the anterior wall of the chest by a rather thick layer of the right lung.

Plantar arteries. Medial and lateral plantar artery

On the sole of the foot are two plantar arteries – aa. plantares medialis et lateralis, which represent the terminal branches of the posterior tibial artery.

The thinner of the two a. plantaris medialis is located in sulcus plantaris medialis. At the head of the first metatarsal bone, it ends, connecting with the first plantar metatarsal artery or falling into the arcus plantaris; along the way gives branches to the adjacent muscles, joints and skin.

Larger a. plantaris lateralis goes to the sulcus plantaris lateralis, to the medial side of the base of the V metatarsal bone, where it turns steeply to the medial side and, forming an anastomosis with the ramus plantaris on the bases of the metatarsal bones with an anterior swell a. dorsalis pedis. In addition, it gives a sprig to connect with a. plantaris medialis. Thus, the arteries of the sole, experiencing constant pressure while standing and walking, form two arcs, which, unlike the arcs of the hand, are not located in parallel, but in two mutually perpendicular planes: in horizontal – between aa. plantares medialis et lateralis and in the vertical – between a. plantaris lateralis and a. plantaris profundus.

Branches of the lateral plantar artery:
a) branches to the adjacent muscles and skin;
b) aa. metatarseae plantares (four), which at the posterior end of each of the metatarsal gaps are connected to the prothropic posterior posterior arteries, at the anterior end – to the prothoric arteries and disintegrate into the plantar digital arteries, aa. digitales plantares, which from the second phalanx send branches to the back of the fingers. As a result, there are two rows of piercing arteries on the foot connecting the vessels of the rear and the soles. These piercing vessels, connecting aa. metatarseae plantares with aa. metatarseae dorsales, thereby forming anastomoses between a. tibialis anterior and a. tibialis posterior. Therefore, it can be said that these two main arteries of the tibia have on the foot in the tarsus area two types of anastomoses: 1) arcus plantaris and 2) rami perforantes.

Arteries of the foot. Dorsal artery of the foot

The branches of the dorsal artery of the foot At the rear of the foot passes a. dorsalis pedis, the dorsal artery of the foot, which is a continuation of the anterior tibia artery, located on the bones in the ligaments and having medially from the tendon of the long extensor of the thumb, and lateral – medial abdomen of the short extensor of the fingers. Here on a. dorsalis pedis, you can determine the pulse by pressing it against the bones. In addition to 2 – 3 skin sprigs branching out in the skin of the rear and the medial side of the foot, the dorsal artery of the foot gives the following branches:

1. Ah. tarseae mediales, medial tarsi arteries, β€”to the medial edge of the foot.

2. A. tarsea lateralis, lateral tarsal artery; moves to the lateral side and at its end merges with the next branch of the artery of the foot, namely with the arcuate artery.

3. A. arcuata, arcuate artery, moves away against the medial sphenoid bone, is sent to the lateral side along the bases of the metatarsal bones and anastomoses with the lateral tarsal and plantar arteries; arcuate artery gives anteriorly three aa. metatarseae dorsales – the second, third and fourth, bound in the corresponding interosseous metatarsal intervals and dividing each into two aa. digitales dorsales to the sides of the fingers facing each other; each of the metatarsal arteries gives the piercing branches, anterior and posterior, extending to the sole. Often a. arcuata is weak and is replaced by a. metatarsea lateralis, which is important to consider when studying the pulse on the arteries of the foot with endarteritis.

4. A. metatarsea dorsalis prima, the first dorsal metatarsal artery, represents one of the two terminal branches of the dorsal artery of the foot, goes to the gap between the I and II fingers, where it is divided into two finger branches; even earlier division gives the branch to the medial side of the thumb.

5. Ramus plantaris profundus, the deep plantar branch, the second, larger of the terminal branches into which the dorsal artery divides, goes through the first interplusar spacing to the sole, where it participates in the formation of the plantar arch, arcus plantaris.

Rear tibial artery

The branches of the posterior tibial artery A. tibialis posterior, the posterior tibial artery, is a continuation of the popliteal artery. Going down the canalis cruropopliteus, it is on the border of the middle third of the leg with the bottom coming out from under the medial edge m. solei and becomes more superficial. In the lower third of the leg a. tibialis posterior lies between m. flexor digitorum longus and m. flexor hallucis longus, medial to Achilles tendon, covered here only with skin and fascial sheets. Walking around the back of the medial ankle, it is divided on the sole into two of its final branches: aa. plantares medialis et lateralis. Pulse a. tibialis posterior is felt by pressing it against the medial ankle.

The largest branch of the posterior tibial artery a. peronea (fibularis), peroneal artery, moving away from a. tibialis posterior in the upper third of the last, is sent to canalis musculoperoneus inferior and ends at the heel bone.

A. tibialis posterior and a. peronea on its way give branches to nearby bones, muscles, joints (posterior ankle branches) and skin.

Anterior tibial artery

The branches of the anterior tibial artery. A. tibialis anterior, the anterior tibial artery, is one of two terminal branches of the popliteal artery (smaller in caliber). Immediately after the onset, it pierces the deep muscles of the flexor surface of the tibia and through the hole in the interosseous membrane goes into the anterior region of the tibia, passes between m. tibialis anterior and m. extensor digitorum longus, and below lies between m. tibialis anterior and m. extensor hallucis longus. Above the ankle joint, it passes superficially, covered with skin and fascia; its continuation on the back of the foot is called a. dorsalis pedis.

The branches of the anterior tibial artery, a. tibialis anterior:
1. A. recurrens tibialis posterior, posterior recurrent tibial artery (up to the opening), to the knee joint and to the joint between the fibula and painful tibial bones.
2. A. recurrens tibialis anterior, the anterior recurrent tibial artery (after the opening), goes to the lateral edge of the patella, participating in the formation of the rete articulare genus.
3. Ah. malleolares anteriores medialis et lateralis, anterior ankle arteries, lateral and medial, are involved in the formation of rete malleolare mediale et laterale.

Popliteal artery.

The branches of the popliteal artery A. poplitea, the popliteal artery, is a direct continuation of the femoral artery. In the popliteal fossa a. poplitea is located on the bone itself (where it can be pressed against the bone in the half-bent position of the limb) and the posterior surface of the articular capsule anteriorly and somewhat medially from v. poplitea; further down the artery lies on the back surface m. popliteus covered heads m. gastrocnemius, and then, going under the edge of m. soleus, is divided into two final branches (aa. tibiales anterior et posterior).

1. Ah. genus superiores lateralis et medialis, the upper knee arteries, lateral and medial, extend at the level of the upper edge of the condyle of the condyle; each around the knee joint goes around to its front surface, where, joining the fistula between them, they participate in the formation of the arterial network of the knee joint (rete articulare genus).

2. Ah. genus inferiores lateralis et medialis, the lower knee arteries, lateral and medial, in the region of the knee joint branch like the upper arteries, but depart from a. poplitea at the level of the lower edge of the condyle of the femur.

3. A. genus media, the middle knee artery, extends in the middle between the upper and lower arteries of the knee joint, pierces the articular capsule and forks in the cruciate ligaments.