What Is the Vastus Lateralis?

Femoral vein: The condylar vein continues at the fissure of the adductor tendon and passes through the adductor tube to the femoral triangle at the rear of the femoral artery.

Femoral vein: The condylar vein continues at the fissure of the adductor tendon and passes through the adductor tube to the femoral triangle at the rear of the femoral artery.

Chinese name

Femoral vein

Foreign name

femoral vein

Department

Vascular surgery

Femoral Vein Overview

One of the deep veins of the lower limbs. This vein receives superficial and deep venous blood from the lower extremities, and receives blood from the superficial abdominal wall and the external genital vein at the oval fossa. The deep side of the ascending femoral vein through the inguinal ligament continues to the external hip vein. This vein may be damaged by trauma or fracture. Excessive swelling of the lymph nodes in the groin can compress this vein, causing venous reflux disorders in the lower limbs.

Physiological significance of femoral vein

The femoral vein continues upward from the vein at the tendon fissure, with the femoral artery ascending to the deep iliac ligament and migrating to the external iliac vein. When the femoral vein passes through the adductor tube, it is located posterolaterally to the femoral artery, at the femoral triangle, behind the artery, and to the medial side of the artery when it reaches the bottom of the femoral triangle. The femoral vein receives the return of the genus branch and the great saphenous vein with the same name as the branch of the femoral artery. The outer diameter of the femoral vein is generally slightly thicker than the accompanying arteries. Some visible double femoral veins. Since the femoral vein is from the deep femoral vein to the saphenous femoral point, there is no valve, and there is at most one valve in the femoral vein and the external iliac vein above the saphenous femoral point. The vein above the point is supported by only one valve, or directly acts on the valve above the great saphenous vein and the valve above the opening of the deep femoral vein. In this way, great saphenous varicose veins and deep vein insufficiency are prone to occur. The femoral vein is superficial at the base of the thigh and is easy to locate (medial to the midpoint of the inguinal ligament). It is one of the common approaches for deep vein puncture and catheterization. There are two types of femoral veins: superficial and deep veins. In addition to the great saphenous vein, the branches of the great saphenous vein, such as the superficial abdominal vein, the superficial iliac vein, and the external genital vein, can sometimes be directly imported; the deep veins include the deep femoral veins and the lateral femoral veins.

Pathophysiology of the femoral vein and lower limb venous system

(A) Superficial veins of lower limbs

The great saphenous veins have many variations, and their number ranges from 2 to 7 branches. The changes in the femoral vein are also large. Care should be taken during surgery. If there is no ligation or omission during the operation, varicose veins on the vaginal wall will remain. According to Dodd et al., 23.3% of pregnant women have varicose veins; double saphenous veins sometimes appear in the thigh, and omissions during surgery are often one of the reasons for recurrence of varicose veins after surgery. The saphenous veins below the knee are often accompanied by saphenous nerves, and the veins on the medial malleolus are close to the saphenous nerves, which are easily damaged during surgery. Especially in minimally invasive varicose veins, the saphenous nerve cutaneous branch is often damaged, causing postoperative calves. Skin numbness.

There are many communication veins (perforating branch veins) between the large and small saphenous veins and the deep vein system. There are fewer communication veins in the thighs, and there are many and complicated communication veins in the lower legs. It is clinically important. Reflux disease has important pathophysiological significance. In particular, the perforating branch vein on the medial malleolus. In the case of venous hypertension of the lower leg, the posterior arch of the lower leg and the perforating branch vein valve are incompletely closed and the subcutaneous venous is dilated, and even the depression at the back of the medial malleolus is filled. It plays a key role in the formation of pathophysiological changes of venous blood stasis in the foot region, and it is the formation of ulcer-prone sites.

(B) deep vein system

1. The common iliac vein is compressively narrowed due to anatomical factors and other reasons, especially where the left common iliac vein enters the inferior vena cava, which leads to venous return disorders of the lower limbs, prone to deep vein thrombosis of the lower limbs, which is good for the iliac vein compression syndrome. Hair site.

2. Internal iliac vein system

(1) The iliac veins mainly flow into the venous blood of the pelvic cavity. When accompanied by arteriosclerosis occlusion, aneurysms often accompanied by perivascular inflammation, inflammatory adhesions are tight, the iliac vein is often damaged during surgical separation, causing venous bleeding that is difficult to stop bleeding.

(2) The superior gluteal vein flows into the internal iliac vein. Compensatory collateral establishment of lower limb venous return disorders often extends upward to the external iliac vein and inferior vena cava. At this time, the pelvic veins dilate and provide the main venous channels for the blood return of the femoral vein system; when these veins are damaged by surgical operations (such as pelvic surgery), it may seriously hinder the venous return and cause edema in one or both legs .

(3) The main trunk of the inferior gluteal vein is opened in the distal part of the internal iliac vein. In addition to the function of the "venous pump", the inferior gluteal vein also provides a collateral circulation between the femoral vein and the internal iliac vein. Pathway; the middle rectal venous plexus returns to the internal iliac vein via the middle rectal vein, and the upper part returns to the superior rectal vein, which is the starting end of the sub mesenteric vein (a genus of the portal vein). This establishes communication between the portal and systemic veins through the rectal venous plexus.

3. The femoral vein system is the main channel that collects superficial and deep venous blood from the lower limbs and returns to the iliac-caval vein. It is clinically important for venous return of the limbs.

(1) In the venous system of the lower limbs, the number and location of deep vein valves vary from person to person and from vein to vein. A fairly constant relationship exists between the venous valve and its branches, that is, on the far side where the vein divides into a medium-sized branch, there is almost constant a valve. Among them, there are 2 pairs of constant valves, saphenous-femoral vein valve, and the first pair of superficial femoral veins. When various causes of venous hypertension and congestion in the lower limbs, the gravity of the blood column causes the primary deep vein valve to be insufficiency and cryptic Femoral vein valve dysfunction often coexists. When clinically, the primary and deep deep venous valve insufficiency is often used as the first pair of constant superficial femoral valves for various valve repairs. For example, the first pair of valves of the superficial femoral vein were selected for valvuloplasty, valve transplantation, valve annulus, and invasive valve band or full annulus contraction in our hospital.

(2) The disease progresses. Once the valve damage crosses the iliac vein plane, the tibiofibular vein is affected, which causes the deep vein valve of the calf to be destroyed, and the blood flows back to the far side, which in turn causes the deep deep vein and the branch vein valve to be damaged. Countercurrent and stasis in the superficial subcutaneous veins, clinically obvious symptoms, such as bulging pain (also known as venous pain) and swelling when standing for a long time; the valvular branch valve in the foot and boot area is damaged, and the skin will rapidly undergo nutritional changes: Rough skin desquamation, itching, exudation of eczema-like dermatitis, hyperpigmentation, and ulcer formation; as the course of the disease prolongs, the skin and subcutaneous fibrosis, the skin is tough, dense, and elastic, and the skin is as hard as leather, causing sclerosis Dermatitis, scar ulcers, and recurrent episodes are persistent and become chronic recurrent ulcers (also known as refractory ulcers).

(3) The clinical value of the common femoral segment vein in anatomy, pathophysiology: The common femoral segment vein collects the blood from the confluence of the great saphenous vein, deep femoral vein, and superficial femoral vein, which is the trunk channel of the deep and superficial veins of the lower limbs. Once thrombosis occurs, the limb swells quickly. When acute complete venous thrombosis occurs (such as femoral bruising), the lower limb venous return is severely impeded. The entire venous system of the lower limb, including the potential collaterals, is almost completely blocked. Extremely high pressure, lymphatic reflux cannot compensate, extreme swelling of the limbs, secondary to acute limb ischemia, venous necrosis often occurs if not handled in time, endangering limbs and even life-threatening; When chronic sequelae of residual thrombosis, chronic femoral section Venous thrombosis is re-opened, and thrombotic mechanized reticular fibrous tissue remains in the lumen, which hinders the deep and shallow venous return of the limb. It is used for general treatment or simple intravenous interventional endovascular treatment and various venous bypass operations. Fewer problems, more leftover problems, and a higher relapse rate. According to the author's clinical practice experience, whether in the acute phase of surgery or endoluminal therapy, chronic sequelae venous bypass surgery or endovascular interventional therapy, the veins in the femoral segment must be opened and cleared to remove the venous thrombus and organic fibrous tissue in the femoral segment. Open the large saphenous vein and deep femoral vein return outlet, and then perform venous bypass or intraluminal interventional treatment on this basis to make the deep and superficial vein outlet return passages clear, which can effectively relieve the congestion of the lower and deep veins of the lower limbs.