General plan of the venous bed structure
The systemic venous system is a large-scale network collecting blood from the entire periphery to the heart. According to the general scheme, venous drainage is directed through the superior and inferior vena cava systems.
This extensive anatomical section traditionally includes:
- Veins of the trunk (azygos and hemiazygos, posterior intercostal, and brachiocephalic veins).
- Vessels of the head and neck (including the jugular trunks and their tributaries).
- Intracranial venous structures: dural venous sinuses, ophthalmic veins, diploic veins, emissary veins, as well as superficial and deep cerebral veins.
- Veins of the upper limb.
Further study of the venous system involves examining the portal vein, the pelvic vascular bed, the lower limb, and the vertebral venous plexuses.
Topography of the subclavian vein
The subclavian vein (v. subclavia) is the direct continuation of the axillary vein (v. axillaris). Its topography has strict landmarks: the vessel lies on the upper surface of the first rib and passes through the scalene hiatus (spatium ante scalenum). Here it is located anterior to the attachment site of the anterior scalene muscle (m. scalenus anterior). The vein ends on the posterior surface of the sternoclavicular joint (articulatio sternoclavicularis).
At the point of confluence the vessel is equipped with a bicuspid valve. Merging with the internal jugular vein (v. jugularis interna), the subclavian vein forms the brachiocephalic vein (v. brachiocephalica). The location of this confluence is called the venous angle (angulus venosus) — right or left, respectively.
Tributaries of the subclavian vein include:
- Dorsal scapular vein (v. dorsalis scapulae) — forms an anastomosis with the external jugular vein.
- Pectoral veins (vv. pectorales) — may also drain into the cephalic or axillary veins.
- Thoracoacromial vein (v. thoracoacromialis) — an inconstant tributary accompanying the artery of the same name and often draining into the superficial veins of the arm.
Veins of the forearm: superficial and deep
In the forearm, there is a clear division into superficial and deep venous networks running beneath the forearm fascia (fascia antebrachii). Superficial vessels include the cephalic vein (v. cephalica), running along the lateral margin, and the basilic vein (v. basilica), running along the medial margin. In the cubital fossa, they are connected by an anastomotic vessel (vas anastomoticum).
Deep veins always accompany arteries and nerves, forming neurovascular bundles:
- Radial bundle (lateral): runs along the brachioradialis muscle (m. brachioradialis), includes the radial veins and artery (a. et vv. radiales), and the radial nerve (n. radialis).
- Ulnar bundle (medial): contains the ulnar vessels (a. et vv. ulnares) and the recurrent ulnar artery.
- Median bundle: represented by the median nerve (n. medianus) running centrally.
- Interosseous vessels: lie on the interosseous membrane, including the anterior interosseous artery and its venae comitantes (vv. comitantes).
Landmarks in this region include the biceps brachii muscle (m. biceps brachii), pronator teres muscle (m. pronator teres), and flexor digitorum profundus muscle (m. flexor digitorum profundus).
Venous bed of the hand
In the hand (manus), the vascular network forms complex structures. An important element is the superficial palmar arch (arcus palmaris superficialis). It gives rise to the common and proper palmar digital veins (vv. digitales palmares communes et propriae).
Blood supply and drainage in this region are closely related to muscle groups:
- Thenar eminence: abductor pollicis brevis muscle (m. abductor pollicis brevis) and flexor pollicis brevis muscle (m. flexor pollicis brevis).
- Hypothenar eminence: abductor digiti minimi muscle (m. abductor digiti minimi).
Many major vessels and nerves of the hand pass beneath a dense band — the flexor retinaculum (retinaculum mm. flexorum).
Briefly: answers to topical questions
Where does the brachiocephalic vein drain?
The right and left brachiocephalic veins (vv. brachiocephalicae dextra et sinistra) unite to form the superior vena cava (v. cava superior). Thus, they carry blood directly into the superior vena cava, which is a major vessel collecting blood from the head, neck, upper limbs, and thorax.
Which venous arches and networks are distinguished in the hand?
The hand features two palmar venous arches and several venous networks.
- Superficial palmar venous arch (arcus venosus palmaris superficialis) — poorly developed, accompanies the artery of the same name.
- Deep palmar venous arch (arcus venosus palmaris profundus) — located along the deep arterial arch, consisting of two anastomosing veins.
- Dorsal venous network of the hand (rete venosum dorsale manus / rete venosum dorsalis manus) — formed on the dorsum of the hand, includes dorsal metacarpal veins.
- Deep palmar venous network of the wrist — sends small vessels into the deep arch.
What are the roots of the portal vein?
The roots of the portal vein (v. portae hepatis) are three large abdominal veins.
- Superior mesenteric vein (v. mesenterica superior) — drains blood from the small intestine, cecum, ascending colon, and transverse colon.
- Splenic vein (v. lienalis / v. splenica) — collects blood from the spleen, part of the stomach, and the pancreas.
- Inferior mesenteric vein (v. mesenterica inferior) — collects blood from the walls of the upper rectum, sigmoid colon, and descending colon (often drains into the splenic vein).
What are the tributaries of the inferior vena cava?
The tributaries of the inferior vena cava (v. cava inferior) are divided into parietal and visceral. Parietal tributaries include:
- Lumbar veins (vv. lumbales) — 4 on each side, collect blood from the abdominal wall.
- Inferior phrenic veins (vv. phrenicae inferiores) — paired, collect blood from the inferior surface of the diaphragm.
Visceral tributaries include:
- Hepatic veins (vv. hepaticae) — right, intermediate, and left.
- Suprarenal veins (vv. suprarenales) — the right drains into the inferior vena cava, the left often into the left renal vein.
- Renal veins (vv. renales) — formed at the renal hilum.
- Testicular (ovarian) veins (vv. testiculares / vv. ovaricae) — the right drains directly into the inferior vena cava, the left into the left renal vein.
What are the tributaries of the azygos vein?
The azygos vein (v. azygos) receives blood from the chest wall and mediastinal organs. Its tributaries are:
- Hemiazygos vein (v. hemiazygos).
- Right superior intercostal vein (v. intercostalis superior dextra).
- Right posterior intercostal veins (vv. intercostales posteriores) — from IV to XI, including the subcostal vein (v. subcostalis).
- Right highest intercostal vein (v. intercostalis suprema) — drains into it in some cases.
- Visceral veins — superior phrenic (vv. phrenicae superiores), esophageal (vv. oesophageales), pericardial (vv. pericardiacae), bronchial (vv. bronchiales), and mediastinal (vv. mediastinales).
Class and exam questions
Where is the subclavian vein located?
It lies on the superior surface of the first rib, passes through the scalene hiatus strictly anterior to the anterior scalene muscle, and reaches the sternoclavicular joint.
What is the venous angle?
This is the anatomical area of convergence of the subclavian and internal jugular veins. Their junction forms the brachiocephalic vein.
What are the main superficial veins of the forearm?
The cephalica vein runs along the lateral margin of the forearm, and the basilica vein along the medial. In the area of the cubital fossa, they connect via an anastomosis.
What tributaries drain into the subclavian vein?
Its tributaries are the dorsal scapular vein, thoracic veins, and, in some cases, the inconsistent thoracoacromial vein.
What else to study on this topic
- Azygos and hemiazygos venous system
- Dural venous sinuses and orbital veins
- Superficial and deep cerebral veins
- Portal vein and its tributaries
- Veins of the pelvis and lower limb
- Vertebral venous plexuses
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