CardiovascularSystem·225Chapter1Anterior tibial aCalcaneal retePosteriortibialaLateral planter aMedial plantarrsala.offootLateral tarsal aDeep plantar archarcuateaCommonpalantareepplantaradigital aaDorsalmctatarsalaaProper plantar digital a.Dorsal digital atFig.II-1-36 The arteries of foot健)SongJian（宋Section 4VeinsI.GeneralDescriptionThe veins, beginning in the blood capillaries andendingthe atrium,collect and convey theblood totheright or lefft atrium of the heart.They tend to be largerin diameter and more numerous than arteries, so thecapacity of the venous system is greater than that ofthe arteries. Although the veins are quite similar withValvesarteries in shape, structure and the general distribu-tion, there are some important difference.Systemicveins are classified as superficial and deep veins.The superficial veins lie just beneath the skin (in thesuperficial fascia) and the deep veins lie beneath thedeep fascia and travel usually alongside an artery andFig.II-1-37Venous valvehave the same name as the artery, but certain deepveins of thehead and vertebral column are exceptionprevent the reflux of the blood.The valves are veryto this pattern.The middle and smaller arteries of thenumerous in theveins of the extremities,especially inlimbs are usually accompanied by paired veins fank-theveins of lower limbs.Thereare few or no valvesing them,andthelarge arteries are usually associatedin the veins of the head, neck and thorax, etc. Veinswith single vein. There are many anastomoses be-areusually morevariable in courseand structure thantween the superficial and deep veins.When the deepthat of the arteries.In many regions, such as the pel-veins are obstructed, the superficial veins are import-vis and vertebral column, veins form extensive plex-uses devoid of valves.These plexuses are the basis ofantforthebloodtransmitting.The veins have a lot of tributaries.Most veins areanastomosis between the veins of the trunk, they mayprovided with valves (Fig.I1-1-37) which serve toalso act as blood reservoirs of variable capacity.扫描全能王创建
226.PARTI6ANGIOLOGYthree from theright lung and twofrom the left.TheExcept the pressure difference between the heartveinfrom the middlelobeoftheright lung generallyventricleand atrium,theflowofblood intheveinsisunites with that from the upper lobe in the hilum ofalso aided:bycompressionfromthecontractinglung, so that ultimately two veins, a superior and anmuscles adjacentto them,and ②by thefall in pres-inferior, leave each lung.They perforate thefibroussure in the thorax with each inspiration that drawslayerof the pericardium and open separately into thevenous blood into the thorax as well as air.upperandposteriorpart of the leftatrium.The veins as a whole form main system: the pul-monary veins and the systemic veins.II.Systemic VeinsII.Pulmonary VeinsSystemic Veins are concerned in the generalcirculation. According to the collecting region, theThe pulmonary veins are concerned in the cir-systemic veins may be divided into three groups:culation in the lungs,they are four in number, twothe superior vena cava and its tributaries, the inferi-from each lung,theseveins are without valves.Theyor vena cava and its tributaries, and the veins of thereturn the oxygenatedblood from the lungs to the leftheart (They have been descripted in heart chapter)atriumof theheartTheycommenceinthecapillary(Fig. II-1-38) networkonthewall of thealveoli of the lungs,andjoin together to form a singletrunk from each lobe,Inferior thyroid vIntermal jugularubclavianyLeftbrachiocephalicvRight subclavian vBrachiocephalicvperiorvenacavaAzygosyhemiazygosvPosteriorintercostalHemiazygosRight ascending lumbeftascendinglumbarFig.1-1-38 Superior vena cava and its tributariesthehead,nckupperlimbs, the walland smeorgan1. Superior vena cava and its tributariesofthethorax (except the heart)andaportionofteupper part of the wallofabdomen (Fig.I-1-38)It isThe superior vena cava collects the blood from扫描全能王创建
Chapter1 CardiovascularSystem ·227.body of the mandible,united by the anterior divisiona short venous trunk and formed by the union of theof the retromandibular vein,and then pass over theright and left brachiocephalic veins. It receives theexternal and internal carotid arteries to enters theazygos vein before joining the right atrium.It beginsintermal jugular vein near the greater horn of hyoidbehind the lower border of the first costal cartilagebone. The facial vein has no valves above the angle ofclose to the right border of sternum, descends verti-themouth,it communicates with the cavernous sinuscally on the right of the ascending aorta, and ends inby two routes: firstly,through the angular vein andthe upper part of the right atrium opposite the thirdophthalmic vein which is connected with the cavern-costal cartilage.ous sinus;secondly,bythe deepfacial vein connectedBrachiocephalic veins are two large trunks in theto pterygoid plexus which links to the cavernousroot of the neck and the upper most part ofthe thorax.sinus (Fig.II-1-39,40).Thus infection of the faceThese veins collect blood from the head and neck, theupper limbs and the anterior walls of the thorax asmay spreadtothe cavernous sinus.Thence,theregionbetween thefacial vein around the nose and the upperwell as the abdomen (internal thoracic veins).Eachlip is frequently termed“"the dangerous area"oftheis formed behind the sternoclavicular joint by theunion of the intermal jugular vein and subclavian veinface.Retromandibular vein The tributaries correspond-(Fig. II-1-38, 39)The angle of the union is termedthe venous angle. The right brachiocephalic veining with the branches of the superficial temporal ar-passes almost vertically lateral to the brachiocephalictery form the superficial temporal vein.The maxillarytrunk.The left one runs obliquely downwards and tovein begins in the pterygoid venous plexus.The su-the right, between the upper part of the manubriumperficial temporal vein joins the maxillary vein at thestemi and the three main branches of the aortic arch.root ofthe zygomatic arch toform the retromandibu-Thence, the left one is much longer than the right one.lar vein(Fig.II-1-39).It descends inthesubstanceTributaries of the brachiocephalic veins includeof theparotid gland,and divides into an anterior andthe vertebral veins, the internal thoracic veins and theposterior branches,theformerpasses forwardsunitesinferiorthyroidveins.thefacial vein,and the latter,posteriorbranch,uniteswith the posterior auricular vein and occipital vein to(1) Veins of the head and neckform the external jugular vein which empties into thesubclavian vein.Like the arteries, the veins of the head anasto-The pterygoid venous plexus is placed betweenmose freely and their main tributaries accompany thethe temporalis and pterygoid muscles. It anastomosesarteries of the scalp,most of thevenous blood fromwith the facial vein through the deep facial vein andhead and neck regions returns to the heart through thewith the cavernous sinus by small veins which passinternal jugularveins,the external jugular veins,andthrough theforamen ovale or foramen of vesalius, athevertebralveins.small foramen on the medial side of theforamen1) Internal jugular vein This is usually theovale.largest vein in the neck,which collects thebloodfromIn addition, the internal jugularvein receives thethe brain, superficial parts of theface and neck (Fig.veins of the tongue, the superior and middle thyroidII-1-39).It originates at the base of the skull throughveins,and thepharyngeal veins.the jugular foramen, as a direct continuation of the2)Subclavian veinItis the continuation of thesigmoid sinus, runs downwards through the neckaxillaryvein,and extends fromtheouterborderofthelateral to the internal carotid artery and the commonfirst rib to the posterior of the sternoclavicular joint,carotid artery.The internal jugular vein joins with awhere it unites with the intermal jugular vein to formsubclavian vein to form the brachiocephalic vein be-thebrachiocephalic vein(Fig.I-1-39).Its tributarieshind the sternoclavicular joint.Its chiefextracranialarethe external jugular vein mainly,and sometimestributaries are:the anterior jugular vein. Some veins accompanyingFacial vein begins at the medial angle of thethe branches of the subclavian artery join the brachio-eye (angular vein),and runs obliquely backwardscephalic vein usually.Atthe junction ofthe left inter-and downwards, behind thefacial artery but takes anal jugular veins and left subclavian vein, the venousstraighercurse(Fig.I-1394)dsndsagangle receives the thoracic duct, while theright angletheaneriorborderofthemasseercrossesovertreceives the right lymphatic duct.扫描全能王创建
ANGIOLOGY·228·PARTⅢIAngularveinPterygoid plexusSuperficialtemOPMaxillaryv.Posterior auricular vRetromandibularyOccipitaly.Facial veinExternal jugular Superior thyroid v.Intermal jugular v.Anterior jugular v.Intermal carotidaMiddle thyroid v.Inferior thyroidvSubclavian vFig.II-1-39 Veins of the head and neckSuperiorophthalmicvCavemoussinusInferiorophthalmicvPterygoid plexusDeep facial v.Retromandibularv.Facial v.Extemal jugular v.Intermal jugular vFig.II-1-40The communication between facial vein and cavernous sinusExternal jugularvein receivesbloodmainlyfromfinally perforates the deep fascia to end in the subcla-the scalp and face, it runs downwards in the neck, andvian vein in the supraclavicular triangle (Fig.II-1-39).crosses the sternocleidomastoid muscle obliquely,Anterior jugular vein is usually the smallest of the扫描全能王创建
Chapter1 Cardiovascular System 229.jugular veins.It begins below the chin, and descendsThe dorsal digital veins pass along the sides ofin the superficial fascia about 1 cm from the medianthe fingers and joined to one anotherby oblique com-line, and then turns laterally to join the external jug-municating branches.They unite with the adjacentular vein or subclavian vein sometimes.Itterminatessides of the fingers into threedorsal metacarpal veins,in the jugular venous arch in the suprastermal space.which end in the dorsal venous network of hand.Cephalic vein begins in the radial part of the dor-(2) Veins of upper limbsalvenousnetwork of handandwindsupwards roundtheradial sideof theanteriorsurface.ItThey are divided into two sets, superficial andthenascendss along thelateral side of theforearm anddeep veins, which anastomose freely with each other.armandcobetweenthepec-Both sets are provided with valves, which are moretoralismaind deltoid, and finally pierces the deepnumerous in the deep veins than in the superficialfascia to end in the axillary or subclavian veinones.The superficial and deep veins mainly terminateBasilic veinarises from themedial sideof thein theaxillaryvein.dorsal venous network of hand. It ascends along the1) Superficial veins of upper limbThey beginposterior surfaceof theulnarsideof theforearm.Justfrom venous network on the dorsal surface of thebelowtheelbow,ittravelstotheanteriorsurface,andhand and are placed just beneath the skin (Fig. II-1-then ascendsmedial tobicepsbrachi,andperforates41).Theyare the cephalic,basilic and median cubitalthe deep fascia a littlebelowthemiddleof the arm.Itveins, and their tributaries.unites with the brachial veins or runs with the brachi-al vein to end in the axillary vein.Median cubital vein is given offfrom the cephalicveinbelow the elbow,and passesmediallyto join thebasilic vein.Blood sampling,transfusion and intravenous injection in general, are often performed at thebend of theelbow,the largest one,usually themediancubital vein, is commonly selected.Recently the cu-bital veins have become the site for introduction ofcardiac catheters to secure blood samples from theCephalicchambers of the heart and great vessels, or for cardio-angiography.2) Deep veins of upper limbWith the excep-Basilicvtion of the axillary,vein they aregenerally arrangedin pairs, flanking the corresponding artery.They fol-Median cubitallow the arteries as their companions and are given thesame name,such as the radial veins,ulnar veins andbrachial veins.The axillary vein receives the veins of the upperlimb,and extendsfromthelowerborderoftheteresmajor to the outer border of the first rib, where it be-comes the subclavian vein.(3) Veins of the thoraxThe veins of the thorax consist of the brachioce-phalic vein, superior vena cava, azygos vein and itstributaries.1) Azygos vein begins as the continuation of theright ascending lumbar vein (Fig. II-1-38).It entersthe thorax immediately to the right of aorta and tho-racic duct. It ascends along the posterior wall of theFig. II-1-41 Superficial veins of upper limbthorax, to the right of the vertebral column, At the扫描全能王创建
·230.PARTIIANGIOLOGYformedbytheunionofthetwo common iliacveinsfourth thoracic vertebra,it arches forwards over theat thelevelofthefifh lumbarvertebra.The inferiorroot of the right lung to end in the superior vena cava.vena cava ascends in front of the vertebral column.The azygos vein receives the posterior intercostalrighttotheabdominalaorta.Reachingtheliveritisconveins of the right side, thehemiazygos vein,accesso-tained in thesulcusfor inferiorvenacavaofthe liver,ryhemiazvgosveinBronchialveinsandsomeesophand then it passes through the vena caval foramen ofageal veins also enter the azygos vein.thediaphragmtoenerthethoraxFinay,itpiercesth2) Hemiazygos vein begins as the continuation offibrous pericardium to open intotheright atrium.theleft ascending lumbar vein.Itascends on theleftof the thoracic vertebrae as high as the eighth thoracic(2) Veins of the pelvic partvertebra,and then passes across the column to end inthe azygos vein. The hemiazygos vein receives the1) Common iliac vein It is formed by the unionlowerposteriorintercostal and subcostalveins of theof the external and internal iliac veins in front ofleft side, the accessoryhemiazygos vein and somethe sacroiliac joint, and passes upwards obliquely,esophageal veins.it ends on the right side of the fifth lumbar vertebra3)Accessoryhemiazygos vein descends ontheby uniting with opposite one to form inferior venaleft side of the vertebral column,crosses the bodyof the seventh thoracicvertebra and joins theazygoscava2) Internal iliac vein It begins near the uppervein, sometimes it joinsthehemiazygos veins.Thepart ofthegreater sciatic foramen,ascends in compa-accessoryhemiazygos vein receives the leftfourthtony with the internal iliac artery,and joins with theex-eighth posterior intercostal veins.ternal iliac vein to form the common iliac vein at the(4)Vertebralvenousplexuesbrim ofthelesser pelvis.Like arteries,the tributariesof the internal iliac vein can be divided into parietalVertebralvenous plexues zare divided the internaland visceral tributaries.andexternalvertebral venousplexuses.TheinternalParietal tributaries They are the superior glutealvertebral venous plexus lies within the vertebral ca-vein, inferior gluteal vein and obturator vein. Theynal between the periosteum of the vertebrae and thecollect the blood from the regions that the corre-spinal dura mater, and drains blood from the verte-sponding arteries supply.brae,thespinal cord and its membranes.The externalThe visceral tributaries They are the inferior rectalvertebral venous plexus lies in front of the vertebralvein, internal pudendal vein, uterine vein and vesicalbodies and behind the vertebral arches, and drainsvein.They begin in the venous plexuses that surroundbloodfromthevertebral bodiesandthemusclessurthe corresponding organs,bladder,prostate,uterusrounding the vertebrae.The vertebral venous plexusesand vagina. These plexuses communicate freely withdrain into the vertebral,posterior intercostal, lumbareach other and with the parietal tributaries.and lateral sacral veins.The rectal plexus (Fig.II-1-43) consists of twoparts: an internal, in the submucosa, and an exterma,outside the muscular coat of the rectum and anal2. Inferior Vena Cava and Itscanal. The two parts communicate freely with eachTributariesother.Thelowerpartoftheexternal plexus isdrainedby the anal vein into the internal pudendal vein, themiddle part by the inferiorrectal vein into the internal(1)Inferiorvena cavailiac veins, and the upper part by the superiorrectalvein into the inferiormesentericvein which isatribu-The inferior vena cava is the largest venous trunk,tary of the hepatic portal vein.which conveys blood to the right atrium of the heartExternal iliac vein isthe continuation ofthefemofrom the lower half of thebody(Fig.II-1-42).It isral vein.It ascends along thebrim of the lesser pelvis,扫描全能王创建
CardiovascularSystem·231.Chapter1Hepatic v.InferiorvenacavaRightsuprarenalvLeftsuprarenal v.Right renal v.Left renal v.Lumbarv.Lefttesticularv.Right testicularvLeft testicular a.Common iliacv.Internal iliac v.Median sacral vExtermal iliacyUrinarybladderFig.Il-1-422Inferior vena cava and its tributariesSuperiorrectalExtermalrectalvenousplexusInternal rectal venous plexusRectumInferiorrectal v.Internal iliac v.Internal pudendal v.Anal canalAnal v.Fig.Il-1-433Therectalvenousplexus扫描全能王创建
232·PARTIANGIOLOGYampayhaBohsaepovddwto end the common iliac vein in frontofthe sacroiliacalveswhcharemorepentthanhatitheperjoint.It collects the bloodfrom the lower limb and thelimb.lowerportionoftheabdominal wallSuperfcialveins oflowerlimbThey rethegreat and small saphenousveins and theirtibuaries(3)Veins of lowerlimb(F4,45)hedorsaldigtal vns jfomthdoramtatarsaeinwhchunieacroTheycanbedivided,likethoseof the upper limb,the proximal ends ofthe metatarsal bones toform theinto two sets,superficial and deep veins.The super-dorsal venous arch of foot.ficial veins pass in superficial fascia,thedeep veinsSuperficial epigastricvSuperficial iliaccircumflexvFemoral ,ExternalpudendalvSuperficial lateralSuperficial medialfemoralvfemoral v.Great saphenous v.GreatsaphenousSmallsaphenous y.Great saphenousvMedial malleolusDorsalverousarchoffootDorsal venousarchoffootFig.II-1-45The great saphenous veinFig.II-1-44The small saphenous veinthe medial malleolus, and ascends along the medialSmall saphenous vein begins from the dorsal ve-side of the leg to the knee, then runs upwards alongnous arch of foot at the lateral margin of the foot. Itthe posteromedial of the medial condyle of the femurpassesbehindthelateralmalleolusand ascends alongand the medial side of the thigh to the saphenousthe midline of the back of leg. It perforates the deephiatu,whereitdrains intothefmoralveinBforefascia in the lower part of the popliteal fossa, andperforatingthe cribriform fasciaofthesaphenousends in thepopliteal vein.hiaeiethsuficiagasuGreat saphenous vein is the longest vein in theraliliaccireumxinxal undalbody, and begins from the dorsal venous arch of footuiamdiamradsulaat the medial margin of the foot. It passes in front of扫描全能王创建
Chapter1 Cardiovascular System ·233.c. Renal veins are formed by the union of 3-5femoral vein.The saphenous veins frequently become dilatedtributaries which issuefrom the hilum of each kidney.and tortuous, called thevaricosevein.In operationTheypass anterior to the renal arteries,and open intoupon varicoseveinallthetributaries atthegroinhavethe inferior vena cava almost at a right angle. Theleft one crosses in front of theaorta and is thricetheto be ligated as well as the main saphenous trunk.Iflength of the right,it receives the left testicular (orone tributary escapes, it in turn becomes dilated andproduces recurrence of the varices.ovarian)vein and theleft suprarenal vein.d. Suprarenal veins accompany the middle supra-2) Deep veins of lower limb They accompanyrenal arteries.The right one opens into the inferiorthe same name arteries and their branches, The veinsvena cava,and the left oneend in the left renal vein.ofthefoot and leg are generally in pairs.The anteriore. Hepatic veins are usually three in number, theand posteriortibial veins unite toform the poplitealright,middle and leff, and collect the blood which hasvein, which ascends through the popliteal fossa topassed through the liver from the hepatic portal veinthe adductor tendinous opening to become the femo-and hepatic artery.They emerge from the posteriorral vein. The femoral vein accompanies the femoralsurface of the liver and open immediately into theartery and ascends, at first behind the femoral artery,inferiorvena cava as it lies in thegroove on the pos-then medial to it.At the level of the inguinal ligament,terior surface of the liver.the femoral vein is continued with the external iliacvein.(5) Hepatic portal venous system(4) Tributaries of the inferior venaIt includes all theveins collecting theblood fromcavathe abdominal part of the alimentary tract (with theexception of the lowestpartof the rectum and analThey are also divided into parietal and visceralcanal) and from the spleen, pancreas and gallbladder.tributaries (Fig.II-1-42).The blood from these viscera is conveyed into theThey are the inferiorDParietal tributariesliver by thehepatic portal vein.In the liver, this veinphrenic and lumbar veins,which accompanythe cor-ramifies like an artery and ends in capillary like ves-responding arteries.The lumbar veins are connectedsels termed sinusoids.The blood of the portal venousby a longitudinal vessel which is termed the ascend.system therefore passes through two sets of"exchangeing lumbar vein.vessels":the capillaries of the alimentary tract,2)Visceral tributariesspleen, pancreas and gallbladder; and the sinusoidsa. Testicular veins arise from the testis and epidid-of the liver.Thehepatic portal vein and its tributariesymis and form a convoluted plexus, called the pamp-have no valves.iniform plexus, the chiefconstituents ofthe spermaticThe hepatic portal vein is about 6-8 cm long, andcord. The veins of the plexus pass through the ingui-is formed by the union of the superior mesenteric andnal canal to the abdomen, where they unite to formsplenic veins behind the neck of pancreas.It passesthe testicular vein which ascends with the testicularupwards behind the first part of the duodenum, andartery.Theright testicular veinopens intothe inferiorthen ascends in therightborder ofthe lesser omentumvena cava with an acute anglea litle below the levelto reach the porta hepatis where it divides into rightoftherenalveinand theletoneopens intoleftrenaland left stems,which accompany the correspondingvein at aright angle (Fig. II-1-42).branches of theproper hepatic artery into the sub-b.Ovarian veins in thefemale correspond withstance of the liver.It is placed behind the commonthetesticularveins inthemale.Eachforms thevebile duct and the proper hepatic artery in the lessernous plexus neartheoarywoveinsarisefromthomentum.plexus and ascend accompanying theovarian artery1) Main tributaries of the hepatic portal veinandsoonfueogetherominglevesselheir(Fig.-1-46)furher course and theirmodeofterminationarethea. Superior mesenteric vein ascends on the rightsame as those of the testicular veins.扫描全能王创建
·234.PARTⅢIANGIOLOGYe.Inferior mesenteric vein begins at the rectum asof the superior mesenteric artery to the neck of thethesuperiorrctalvein,runsinmpanying withthepancreas, where it unites with the splenic vein tocorresponding artery andopens intothesplenic veinform the hepatic portal vein.The superior mesentericbehind thebody of the pancreas.It sometimes mayvein receives the veins from the organs supplied bydeviate to theright and enter the superior mesentericthe branches of the superior mesenteric artery, alsoveinor the junction of above two veins.This vein colreceives the right gastroepiploic vein and, occasion-lectsbloodfromthedescendingcolon,sigmoidcolonally,the inferiormesenteric and pancreaticoduodenaland the rectum.veins.d.Leffgastricveinruns withthelefgastricarteryb.Splenicvein commences from five or sixand opens into the hepatic portal vein at the uppertributaries issuing from the spleen and traverses toborder of the first part of the duodenum.the right behind the body of the pancreas and belowe. Rightgastric vein isofsmallsize, runsfromsplenic artery.It ends behind the neck of pancreasleftorightalongthepyloricportionofthelessercurwhere it unites with the superior mesenteric vein tovature of the stomach,and ends in the hepatic portalformthehepaticportalvein.Thesplenicvein receivesvein.the short gastric,left gastroepiploic,thepancreaticvein,andtheinferiormesentericveins.CysticHepatic portal vRightgastricSplenic v.Rightgastroepiploicv.SuperiormesentericInferior mesentericy.Superior rectal vFig.I-1-46 Main tributaries of the hepatic portal veinf. Paraumbilical vein are several small veins,be-2) Anastomoses between the hepatic portal ve-gin at the umbilicus and run along the ligamentumnous system and thevena caval system (Fig.I-47)teres hepatis to end in the hepatic portal vein.These anastomoses,which may collectively offerang. Cystic vein collects the blood from the gall-effectivecllateralcirculationincaseofobstructionbladder and opens into the hepatic portal veins or itsofthehepatic portal vein,areasfollows:Intheaomial part fthe esophagus, tibutariesright branch.扫描全能王创建