Lada Eberlová 1; Jakub Tolar 1; Jan Mikuláš 1; Jiří Valenta 1; Jitka Kočová 2; Jana Hirmerová 3; Pavel Fiala 1
Univerzita Karlova v Praze, Lékařská Fakulta v Plzni, Ústav anatomie
1; Univerzita Karlova v Praze, Lékařská Fakulta v Plzni, Ústav histologie a embryologie
2; 2. interní klinika FN Plzeň
Čas. Lék. čes. 2011; 150: 344-346
Deep venous system is known for its extreme variability but still in anatomy it is on the border of interest. Although a few previous anatomical studies have already pointed out the fact of a significant discrepancy between the autopsy findings and the literary description, it has not had any particular output so far. Our findings confirmed the deep femoral vein (DFV) to be an alternative collateral vein connecting the popliteal vein (PV) with the femoral vein (FV).
Key words: deep veins, deep femoral vein, collaterals, varieties
veins of the thigh run in the lower limb between the skeletal
muscles, covered with fascia. The femoral vein passes alongside the
same named artery from the adductor canal up to the inguinal
ligament. Both vessels are found in the vascular lacuna, the vein is
medial to the artery here. In the anatomical textbooks the
description of the femoral vein and its tributaries is usually very
sketchy and commonly only the great saphenous and the deep femoral
veins are mentioned. Among the alternative tributaries of the deep
femoral vein the medial and lateral femoral circumflex veins are
named. The vein is constituted by fusion of the venae comitantes of
the perforating arteries (1, 2, 3).
clinical purposes the anatomical nomenclature of DFV has been
up-dated and the following segments are newly distinguished (4):
femoralis communis (common femoral vein), a short segment of the
vena femoralis between its confluence with the vena profunda
femoris and the inguinal ligament, and
femoralis (femoral vein), which originates from the popliteal vein
and stretches between the hiatus adductorius and the confluence with
the vena profunda femoris.
often used term “vena femoralis superficialis” for the deep
femoral vein has not ever been a part of any nomenclature and it is
found to be confusing from the topografical point of view (4, 5, 6).
superficial and the deep limb veins form a functional unit. Both of
the systems are interconnected by perforators, valves regulate the
blood flow centripetally. Deep veins drain 90 % of the limb blood.
perforators (transfascial connections between the superficial and
deep veins) are in the thigh less frequent than in the leg and are
very variable. They may form even a subfascial venous system. In the
femoral region they mostly arise from the great saphenous vein
tributaries, most of the perforators possess valves. In the thigh the
following perforators are distinguished (6, 7):
anteromedial (connect the great saphenous vein with FV) and inguinal
(piercing the quadriceps femoris muscle)
posteromedial (through adductors) and posterolateral (through the
biceps femoris muscle)
of the venous wall and valves displays a great variability. Wall
stratification is similar to arteries, boundaries between the layers
are less distinct. Tunica intima is formed by endothelium and
subendothelium: longitudinally oriented elastic fibres may in the
lower limb veins cumulate in the internal elastic lamina. Tunica
media is thinner in veins comparing with the same sized arteries.
Collagen and sparse elastic fibres are found here. There are even
smooth muscle cells arranged into spiral bundles in the propulsive
veins. Tunica adventitia is the most prominent layer in veins. It is
formed by large amounts of collagen and longitudinally oriented
bundles of elastin and smooth muscle cells.
are a fundamental venous structure. They are found in all veins
distally to the external iliac vein. Valves develop as a duplication
of all layers of intima, formed usually by 2 – 3 cusps. To prevent
regurgitation they are situated under the opening of a tributary. The
more distally in bloodstream, the more valves there are. FV holds 2 –
3 valves, the great saphenous vein 14 – 18 (small saphenous vein
20), whereas 2 valves at minimum are present in the saphenofemoral or
the saphenopopliteal junction.
width of lumen and the course of veins show a considerable
variability that may be caused also by the developmental
abnormalities (malformations). The early developmental stage of veins
in human according to Dvorak (8) shows Fig. 1.
a finlike base of the lower limb the blood is drained by the marginal
veins – v. marginalis tibialis et fibularis. The tibial marginal
vein perishes, while from the fibular one develops the main stem that
opens into the v. cardinalis posterior, later into the v.
hypogastrica. The distal segment of v. marginalis fibularis runs from
the knee superficially and forms the great saphenous vein, while the
proximal segment is found in the depth under the thigh flexors and
targets as the v. ischiadica accompanying the infrapiriform foramen.
The great saphenous and femoral vein develop then, the latter
connects proximally with the v. ischiadica. It eventually perishes
and the main blood vessels evolve in the thigh anteriorly. V. glutea
inferior remains from the former v. ischiadica and may become a
variable collateral vein called v. femoralis dorsalis (9).
following venous anomalies and malformations are distinguished:
– congenital absence of the entire vein or its segment
– defective development causing below normal size of vein
– is similar to aplasia, but less severe
– complex abnormality of development (of size, structure or
„doubling“ – complete or incomplete – causes usually FV or
embryonic veins – v. ischiadica most frequently
variability of FV has been proved also by our own autopsy findings.
In the last autumn during the routine dissection we found in both
limbs of an 80-years-old man an atypical vein, that attained a
diameter of 1 cm and run as a FV collateral (Fig. 2, 3). This
non-doubled vein, 0.95 cm in diameter, arised from the popliteal
vein. It received many muscular tributaries in the femoral region,
its diameter 10 cm below the sciatic tuberosity was 1.2 cm (diameter
of the femoral artery at the corresponding level was 0.9 cm). The
vein drained laterally into the femoral vein 13 cm below the inguinal
ligament. The diameter at the site of its orifice was 1.2 cm. Valves
were centripetally oriented, histological examination showed an
average venous wall structure.
autopsies of the distal femoral region of 4 women and 2 men (age 73 –
88) proved the presence of a similar finding in 3 out 11 dissected
extremities, concretely in one man bilaterally, in a woman
unilaterally (the second limb was used for other purposes and thus
could not be dissected).
spite of the deep venous thrombosis importance very little attention
is paid to the deep lower limb vein variability in the current
anatomical and clinical textbooks. Several previous anatomical
studies have already pointed out the distinctive discrepancy between
the autopsy findings and the literary description (10, 11). Study by
Mavor et al. is in the description of the connection between DFV and
veins in the popliteal fossa the most detailed. In 22 dissected lower
limbs DFV had a direct communication with PV in 38 %, in 48 % via
indirect tributaries of the latter. Thus in 86 % the DFV was found to
be a potential collateral of the lower femoropopliteal segment. The
vena femoropoplitea, which is in some texts (3, 4, 12) described as a
variable vein on the dorsal aspect of thigh opening into the small
saphenous vein, is not in the most foreign textbooks mentioned and
could not be proved by our autopsy findings either. Therefore it is
suggested that the femoropopliteal vein is likely to be a variable
deep femoral vein as well.
variable deep femoral vein, a large vein connected with the popliteal
vein, may serve as an important collateral in case of the femoral
vein occlusion, e. g. in traumatic thrombosis in the adductor canal.
Knowledge of this variety might be found useful also for the
interpretation of some imaging methods.
Eberlova, M.D. Charles
University in Prague, Faculty of Medicine in Pilsen Department
of Anatomy Karlovarská
48, 301 00 Plzeň E-mail:
firstname.lastname@example.org tel. 00420 377 593 300
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12. Petrovický P, et al. Anatomie s topografií a klinickými aplikacemi. Martin: Osveta 2001; s. 484.
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