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