Veins of the Lower Extremity USMLE, Limited Edition > Gross Anatomy > Gross Anatomy

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Veins of the Lower Extremity USMLE, Limited Edition > Gross Anatomy > Gross Anatomy KEY POINTS: Superficial veins • Cephalic vein, laterally • Basilic vein, medially • Often visible through the skin Deep veins • Typically travel with, and share the names of, the major arteries. • Often paired, meaning that, for example, two brachial veins travel side by side within the arm. BRANCH DETAILS: Deep veins • Deep plantar venous arch Drains into the posterior tibial vein • Posterior tibial vein Arises in the leg between the deep and superficial posterior muscular compartments. • Fibular (aka, peroneal) vein Arises laterally and rises to drain into the posterior tibial vein • Dorsal pedal venous arch Drains into the anterior tibial vein • Anterior tibial vein Ascends within the anterior compartment of the leg and wraps laterally around the proximal leg • Popliteal vein Formed by merger of anterior and posterior tibial veins in the posterior knee Ascends superficial to the popliteus muscle to become the femoral vein 1 / 2 • Femoral vein Travels through the adductor hiatus, through antero-medial thigh to become external iliac vein after passing under inguinal ligament. Tributaries include: - Circumflex veins - Deep femoral vein • External iliac vein Converges with the internal iliac vein to form the common iliac vein • Common iliac veins Right and left sides merge to form inferior vena cava, which returns blood to the heart Superficial Veins • Dorsal venous arch Drains the superficial tissues of the foot • Great saphenous vein Ascends along the medial aspect of the lower extremity, then drains into the femoral vein in the proximal thigh To do so, the great saphenous vein dives deep to the fascia of the leg via the saphenous opening • Small saphenous vein Arises from the dorsal venous arch and wraps posteriorly; it ascends within the leg, and then drains into the popliteal vein at the knee Mnemonic: NAVL = the femoral Nerve, Artery, Vein, and Lymph nodes travel together within the femoral triangle of the anterior thigh Clinical correlations: • Thrombosis of the deep veins of the lower extremity. Pieces of clots in the lower extremity can travel through the systemic veins, pass through the heart, and become lodged in the pulmonary artery, with fatal consequences. • Some authors refer to the femoral vein as the "superficial femoral vein," given that it lies relatively superficially in the groin; however, this terminology can be dangerously misleading if a clinician fails to recognize that the vein is part of the deep venous network and is dismissive of thrombosis of the "superficial femoral vein." Powered by TCPDF (www.tcpdf.org) 2 / 2.

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Lower Extremity Deep Venous Thrombosis
SECTION 5 Vascular System CHAPTER 34 Lower Extremity Deep Venous Thrombosis Ariel L. Shiloh KEY POINTS • Providers can accurately detect lower extremity deep venous thrombosis with point-of- care ultrasound after limited training. • Compression ultrasound exams are as accurate as traditional duplex and triplex vascular ultrasound exams. • Compression ultrasound exam at only two sites, the common femoral vein and popliteal vein, permits rapid and accurate assessment of deep venous thrombosis. Background care providers can perform lower extremity compression ultrasonography exams rapidly Venous thromboembolic disease (VTE) is a and with high diagnostic accuracy to detect common cause of morbidity and mortality in DVT. 7–13 A meta-analysis of 16 studies showed hospitalized patients and is especially preva- that point-of-care ultrasound can accurately lent in critically ill patients.1–3 Approximately diagnose lower extremity DVTs with a pooled 70% to 90% of patients with an identified source sensitivity of 96% and specificity of 97%.14 of pulmonary embolism (PE) have a proxi- Traditional vascular studies, the duplex mal lower extremity deep venous thrombosis and triplex exams, use a combination of (DVT). Conversely, 40% to 50% of patients two-dimensional (2D) imaging with compres- with a proximal DVT have a concurrent pul- sion along with the use of color and/or spectral monary embolism at presentation, and simi- Doppler ultrasound. More recent studies have larly, in only 50% of patients presenting with a demonstrated that 2D compression ultrasound PE can a DVT be found.4–6 exams alone yield similar accuracy as tradi- Point-of-care ultrasound is readily available tional duplex or triplex vascular studies.9,11,15–17 as a diagnostic tool for VTE.
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Study of Variation of Great Saphenous Veins and Its Surgical Significance (Original Study)
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 2 Ver. 10 February. (2018), PP 21-26 www.iosrjournals.org Study of Variation of Great Saphenous Veins and Its Surgical Significance (Original Study) Dr Surekha W. Meshram1, Dr. Yogesh Ganorkar2, Dr V.P. Rukhmode3, Dr. Tarkeshwar Golghate4 1(M.B.B.S,M.D) Associate Professor, Dept. of Anatomy Govt. Medical College Gondia, Maharashtra 2(M.B.B.S,M.D) Assistant Professor, Dept. of Anatomy Govt. Medical College Gondia, Maharashtra 3 (M.B.B.S, M.S) Professor and Head, Dept. of Anatomy Govt. Medical College Gondia, Maharashtra 4(M.B.B.S, M.D) Assiciate Professor, Dept. of Anatomy Govt. Medical College, Nagpur, Maharashtra Corresponding Author: Dr. Surekha W. Meshram Abstract Introduction: Veins of lower limbs are more involves for various venous disorders as compare to upper limbs. Most common venous disorders occurring in lower limbs are varicose veins, deep venous thrombosis and venous ulcers. Varicose veins are found in large population of world affecting both the males and females. Surgical operations are performed in all over the world to cure it. In the varicose vein surgery, surgeon successfully do the ligation as well as stripping of the great saphenous vein and its tributaries. Duplication of a great saphenous vein can be a potential cause for recurrent varicose veins after surgery as well as complications may occur during the surgery. Method: The present study was done by dissection method on 50 lower limbs of cadavers. Its aim was to identify the incidence and pattern of duplication of long saphenous vein in Indian population.
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Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity
IMAGING/ORIGINAL RESEARCH Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity Srikar Adhikari, MD, MS*; Wes Zeger, DO; Christopher Thom, MD; J. Matthew Fields, MD *Corresponding Author. E-mail: [email protected]. Study objective: Two-point compression ultrasonography focuses on the evaluation of common femoral and popliteal veins for complete compressibility. The presence of isolated thrombi in proximal veins other than the common femoral and popliteal veins should prompt modification of 2-point compression technique. The objective of this study is to determine the prevalence and distribution of deep venous thrombi isolated to lower-extremity veins other than the common femoral and popliteal veins in emergency department (ED) patients with clinically suspected deep venous thrombosis. Methods: This was a retrospective study of all adult ED patients who received a lower-extremity venous duplex ultrasonographic examination for evaluation of deep venous thrombosis during a 6-year period. The ultrasonographic protocol included B-mode, color-flow, and spectral Doppler scanning of the common femoral, femoral, deep femoral, popliteal, and calf veins. Results: Deep venous thrombosis was detected in 362 of 2,451 patients (14.7%; 95% confidence interval [CI] 13.3% to 16.1%). Thrombus confined to the common femoral vein alone was found in 5 of 362 cases (1.4%; 95% CI 0.2% to 2.6%). Isolated femoral vein thrombus was identified in 20 of 362 patients (5.5%; 95% CI 3.2% to 7.9%). Isolated deep femoral vein thrombus was found in 3 of 362 cases (0.8%; 95% CI –0.1% to 1.8%).
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Femoral Injecting Guide
FEMORAL INJECTING A GUIDE TO INJECTING IN THE GROIN USING THE FEMORAL VEIN (This is a restricted document NOT meant for general distribution) AUGUST 2006 1 INTRODUCTION INTRODUCTION This resource has been produced by some older intravenous drug users (IDU’s) who, having compromised the usual injecting sites, now inject into the femoral vein. We recognize that many IDU’s continue to use as they grow older, but unfortunately, easily accessible injecting sites often become unusable and viable sites become more dif- ficult to locate. Usually, as a last resort, committed IDU’s will try to locate one of the larger, deeper veins, especially when injecting large volumes such as methadone. ManyUnfortunately, of us have some had noof usalternat had noive alternative but to ‘hit butand to miss’ ‘hit andas we miss’ attempted as we attemptedto find veins to find that weveins couldn’t that we see, couldn’t but knew see, werebut knew there. were This there. was often This painful,was often frustrating, painful, frustrating, costly and, costly in someand, cases,in some resulted cases, inresulted permanent in permanent injuries such injuries as the such example as the exampleshown under shown the under the heading “A True Story” on pageheading 7. “A True Story” on page 7. CONTENTS CONTENTS 1) Introduction, Introduction, Contents contents, disclaimer 9) Rotating Injecting 9) Rotating Sites Injecting Sites 2) TheFemoral Femoral Injecting: Vein—Where Getting is Startedit? 10) Blood Clots 10) Blood Clots 3) FemoralThe Femoral Injecting: Vein— Getting Where
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Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins
UnitedHealthcare of California (HMO) UnitedHealthcare Benefits Plan of California (EPO/POS) UnitedHealthcare of Oklahoma, Inc. UnitedHealthcare of Oregon, Inc. UnitedHealthcare Benefits of Texas, Inc. UnitedHealthcare of Washington, Inc. UnitedHealthcare® West Medical Management Guideline Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins Guideline Number: MMG121.R Effective Date: July 1, 2021 Instructions for Use Table of Contents Page Related Medical Management Guidelines Coverage Rationale ....................................................................... 1 • Cosmetic and Reconstructive Procedures Documentation Requirements ...................................................... 3 • Embolization of the Ovarian and Iliac Veins for Pelvic Definitions ...................................................................................... 3 Congestion Syndrome Applicable Codes .......................................................................... 5 Description of Services ................................................................. 6 Related Benefit Interpretation Policy Benefit Considerations .................................................................. 7 • Cosmetic, Reconstructive, or Plastic Surgery Clinical Evidence ........................................................................... 7 U.S. Food and Drug Administration ........................................... 21 References ................................................................................... 21 Guideline History/Revision
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Spider Vein and Varicose Vein Treatments
1 Vein & Body Specialists at The Bellevue Hospital Spider Vein and Varicose Vein Treatments What are spider veins? Spider veins are dilated, small blood vessels that have a red or bluish color. They appear mostly on the legs and occasionally on the face. What are varicose veins? Larger, dilated blood vessels called varicose veins may be raised above the skin surface. What is the cause of spider and varicose veins? The only cause of spider and varicose veins is genetics. A gene was passed to you, which caused you to be susceptible to developing spider and/or varicose veins. Contrary to popular belief, spider/varicose veins are not caused by being overweight, pregnancy or standing on your feet for long periods. Think about it – not everyone who is overweight, pregnant or stands on their feet for long periods develop spider/varicose veins. However, if you have the genetic predisposition for varicose and spider veins, pregnancy and being overweight do cause extra pressure on the pelvic/groin veins and cause all the leg veins to become more apparent and enlarged. How can I prevent varicose/spider veins? You cannot prevent varicose/spider veins. Support hose, compression stockings, elevating your legs, avoiding prolonged standing/sitting, avoiding crossing your legs and not being overweight do not prevent varicose veins from occurring, but DO decrease the symptoms of varicose veins and DO prevent them from dilating during prolonged standing and sitting. No research has proven that wearing stockings prevent varicose veins. Wearing stockings DO prevent varicose veins from spontaneously clotting. What are the symptoms of varicose veins? The symptoms of varicose veins are achiness, tenderness and/or burning over the varicose veins.
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Lower Limb Venous Drainage
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Vessels in Femoral Triangle in a Rare Relationship Bandyopadhyay M, Biswas S, Roy R
Case Report Singapore Med J 2010; 51(1) : e3 Vessels in femoral triangle in a rare relationship Bandyopadhyay M, Biswas S, Roy R ABSTRACT vein, the longest superficial vein in the body, ends in the The femoral region of the thigh is utilised for femoral vein, which is a short distance away from the various clinical procedures, both open and inguinal ligament after passing through the saphenous closed, particularly in respect to arterial and opening.(2) venous cannulations. A rare vascular pattern was observed during the dissection of the femoral CASE REPORT region on both sides of the intact formaldehyde- A routine dissection in undergraduate teaching of an preserved cadaver of a 42-year-old Indian intact formaldehyde-preserved cadaver of a 42-year-old man from West Bengal. The relationships and Indian man from West Bengal revealed a rare pattern patterns found were contrary to the belief that of relationship between the femoral vessels on both the femoral vein is always medial to the artery, sides. The femoral artery crossed the femoral vein deep just below the inguinal ligament and the common to the inguinal ligament, such that the artery was lying femoral artery. The femoral artery crossed the superficial to the vein at the base of the femoral triangle. vein just deep to the inguinal ligament so that The profunda femoris artery was seen lying lateral, and the femoral vein was lying deep to the artery at the great saphenous vein medial, to the femoral vessels the base of the femoral triangle. Just deep to the in the triangle.
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The Hemodynamic Characteristic of the Popliteal Vein Is Assessed
Central Annals of Vascular Medicine & Research Mini Review *Corresponding author Cestmir Recek, Department of Surgery, University Hospital Hradec Kralove, Czech Republic, Mantlergasse The Hemodynamic 24A-1130 Vienna, Austria, Email: [email protected] Submitted: 25 March 2021 Accepted: 20 April 2021 Characteristic of the Popliteal Published: 21 April 2021 ISSN: 2378-9344 Copyright Vein © 2021 Recek C Cestmir Recek* OPEN ACCESS Department of Surgery, University Hospital Hradec Kralove, Czech Republic, Austria Keywords • Pressure changes in the popliteal vein, popliteal vein incompetence, small saphenous vein Abstract incompetence, calf pump activity, venous pressure. The hemodynamic characteristic of the popliteal vein is assessed. The hydrostatic pressure in the popliteal vein amounts to about 60 mm Hg at the knee level. Pressure changes are produced by the calf pump activity; they are much mitigated and short-lived in the popliteal vein, which contrasts distinctly with the situation in deep lower leg veins, where the pressure excursions are pronounced. The systolic pressure in the popliteal vein increases by about 25 mm Hg above the hydrostatic pressure during the first calf muscle contraction; the diastolic pressure decreases by about 8 mm Hg below the hydrostatic pressure. The incompetence of the popliteal vein is hemodynamically not relevant; this statement is in contrast with the prevailing opinion. The state of affairs has been documented by plethysmographic examinations. Small saphenous vein incompetence is regularly accompanied by the incompetence of the femoropopliteal venous axis. Abolition of small saphenous vein reflux eliminates the hemodynamic disorders and restores physiological plethysmographic values in spite of the persistent popliteal vein incompetence. The refluxing flow in the popliteal vein disappears after interruption or abolition of small saphenous vein reflux.
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Atrial Fibrillation Ablation
Atrial Fibrillation Ablation Atrial Fibrillation Ablation This handout will help you learn about atrial fibrillation ablation, also called pulmonary vein isolation. © Hamilton Health Sciences, 2008 PD 6062 – 02/2012 dpc/pted/LrgBk/AtrialFibrillationAblation-trh.doc dt/February 27, 2012 2 15 Atrial Fibrillation Ablation Atrial Fibrillation Ablation How does the heart work? Notes: To understand atrial fibrillation, you need to know how the heart’s electrical system works. __________________________________________________________ The sinoatrial node (SA node) is a natural pacemaker. It starts the __________________________________________________________ electrical signal that travels across the upper 2 chambers or atria of the heart to the atrioventricular node (AV node). __________________________________________________________ The AV node transfers the electrical signal from the upper part of the heart to the lower 2 pumping chambers or ventricles. The bundle branches are __________________________________________________________ specialized tissue that help send electrical impulses through the ventricles. This makes a normal heart beat, called normal sinus rhythm. __________________________________________________________ __________________________________________________________ __________________________________________________________ SA node __________________________________________________________ Bundle branches __________________________________________________________ AV node __________________________________________________________
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The Great Saphenous Vein in Situ for the Arterialization of the Venous
ARTIGO ORIGINAL Utilização da safena magna in situ para arterialização do arco venoso do pé The great saphenous vein in situ for the arterialization of the venous arch of the foot Cesar Roberto Busato¹, Carlos Alberto Lima Utrabo², Ricardo Zanetti Gomes³, Eliziane Hoeldtke², Joel Kengi Housome², Dieyson Martins de Melo Costa², Cintia Doná Busato4 Resumo Contexto: O tratamento da isquemia crítica de membros inferiores sem leito arterial distal pode ser realizado por meio da inversão do fluxo no arco venoso do pé. Objetivo: O objetivo deste trabalho foi apresentar a técnica e os resultados obtidos com a arterialização do arco venoso do pé, mantendo a safena magna in situ. Métodos: Dezoito pacientes, dos quais 11 com aterosclerose (AO), 6 com tromboangeíte obliterante (TO) e 1 com trombose de aneurisma de artéria poplítea (TA) foram submetidos ao método. A safena magna in situ foi anastomosada à melhor artéria doadora. O fluxo arterial derivado para o sistema venoso progride por meio da veia cujas válvulas são destruídas. As colaterais da veia safena magna são ligadas desde a anastomose até o maléolo medial, a partir do qual são preservadas. Resultados: Dos pacientes, 10 (55,6%) mantiveram suas extremidades, 5 com AO e 5 com TO; 7 (38,9%) foram amputados, 5 com AO, 1 com TO e 1 com Ta; houve 1 óbito (5,5%). Conclusão: A inversão do fluxo arterial no sistema venoso do pé deve ser considerada para salvamento de extremidade com isquemia crítica sem leito arterial distal. Palavras-chave: Tromboangeíte obliterante; salvamento de membro; arterialização temporal; amputação de membro. Abstract Background: Critical lower limb ischemia in the absence of a distal arterial bed can be treated by arterialization of the venous arch of the foot.
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Clinical Anatomy of the Lower Extremity
Государственное бюджетное образовательное учреждение высшего профессионального образования «Иркутский государственный медицинский университет» Министерства здравоохранения Российской Федерации Department of Operative Surgery and Topographic Anatomy Clinical anatomy of the lower extremity Teaching aid Иркутск ИГМУ 2016 УДК [617.58 + 611.728](075.8) ББК 54.578.4я73. К 49 Recommended by faculty methodological council of medical department of SBEI HE ISMU The Ministry of Health of The Russian Federation as a training manual for independent work of foreign students from medical faculty, faculty of pediatrics, faculty of dentistry, protocol № 01.02.2016. Authors: G.I. Songolov - associate professor, Head of Department of Operative Surgery and Topographic Anatomy, PhD, MD SBEI HE ISMU The Ministry of Health of The Russian Federation. O. P.Galeeva - associate professor of Department of Operative Surgery and Topographic Anatomy, MD, PhD SBEI HE ISMU The Ministry of Health of The Russian Federation. A.A. Yudin - assistant of department of Operative Surgery and Topographic Anatomy SBEI HE ISMU The Ministry of Health of The Russian Federation. S. N. Redkov – assistant of department of Operative Surgery and Topographic Anatomy SBEI HE ISMU THE Ministry of Health of The Russian Federation. Reviewers: E.V. Gvildis - head of department of foreign languages with the course of the Latin and Russian as foreign languages of SBEI HE ISMU The Ministry of Health of The Russian Federation, PhD, L.V. Sorokina - associate Professor of Department of Anesthesiology and Reanimation at ISMU, PhD, MD Songolov G.I K49 Clinical anatomy of lower extremity: teaching aid / Songolov G.I, Galeeva O.P, Redkov S.N, Yudin, A.A.; State budget educational institution of higher education of the Ministry of Health and Social Development of the Russian Federation; "Irkutsk State Medical University" of the Ministry of Health and Social Development of the Russian Federation Irkutsk ISMU, 2016, 45 p.
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