Anatomy of the venous and nervous system of the lower limb
Authors:
D. Trachtová; D. Kachlík
Authors‘ workplace:
Přednosta: prof. MUDr. David Kachlík, Ph. D.
; 2. lékařská fakulta
; Ústav anatomie
; Univerzita Karlova v Praze
Published in:
Prakt. Lék. 2022; 102(5): 228-240
Category:
Reviews
Overview
The venous system of the lower limbs consists of two interconnected units. A deep venous system, the course of which mimics the arterial supply and flows into the pelvic veins, and a superficial venous system, consisting of the vena saphena magna et vena saphena parva, between which there exist numerous variable comunnications. The superficial and deep systems are interconnected by venous perforators. When the perforators are non-functional, venous varices develop. Superficial veins are accompanied by cutaneous nerves. The course of structures shows considerable variability, which is still under investigation. The vena saphena magn is accompanied along the leg by the nervus saphenus, which innervates skin on the ventromedial aspect of the leg. Injury to the nervus saphenus manifests by loss of sensitivity or hyperesthesia, which is very uncomfortable for the patients. Vena saphena parva runs together with the nervus suralis, which serves for neural grafts during reconstruction surgery.
Keywords:
lower limb – peripheral nervous system – superficial veins – superficial nerves – cutaneous nerves
Sources
1. FIPAT. Terminologia Embryologica. 2. Ed. Stuttgart: Thieme 2017.
2. Moore KL, Persaud TVN. Zrození člověka: embryologie s klinickým zaměřením. Praha: ISV 2002.
3. Carlson BM. Human embryology and developmental biology. 4th ed. Philadelphia, PA: Mosby/Elsevier 2009.
4. Sadler TW. Langmanova lékařská embryologie. Praha: Grada Publishing 2011.
5. Standring S. (ed.) Gray’s anatomy: anatomical basis of clinical practice. 39th ed. Edinburgh, UK: Elsevier Churchill Livingstone 2005.
6. Coffey R, Gupta V. Meralgia paresthetica. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2022.
7. Kaiser R. Chirurgie hlavových a periferních nervů s atlasem přístupů. Praha: Grada Publishing 2016.
8. Katritsis E, Anagnostopoulou S, Papadopoulos N. Anatomical observations on the accessory obturator nerve (based on 1000 specimens). Anat Anz 1980; 148(5): 440–445.
9. Tubbs RS, Shoja MM, Loukas M. Bergman’s Comprehensive Encyclopedia of Human Anatomic Variation. Bergman’s Comprehensive Encyclopedia of Human Anatomic Variation. Bergman’s comprehensive encyclopedia of human anatomic variation. Hoboken, New Jersey: Wiley 2016.
10. Tubbs RS, Salter EG, Wellons JC 3rd, et al. Anatomical landmarks for the lumbar plexus on the posterior abdominal wall. J Neurosurg Spine 2005; 2(3): 335–338.
11. Tubbs RS, Miller J, Loukas M, et al. Surgical and anatomical landmarks for the perineal branch of the posterior femoral cutaneous nerve: implications in perineal pain syndromes. Laboratory investigation. J Neurosurg 2009; 111(2): 332–335.
12. Bergman RA, Thompson SA, Afifi AK. Catalogue of human variations. Baltimore and Munich: Urban & Schwarzenberg 1984; 158–161.
13. Bergman RA, Thompson SA, Aww AK, Saddeh FA. Compendium of human anatomical variations. Baltimore: Urban and Schwarzenberg 1988; 143–148.
14. Feigl GC, Schmid M, Zahn PK, et al. The posterior femoral cutaneous nerve contributes significantly to sensory innervation of the lower leg: an anatomical investigation. Br J Anaesth 2020; 124(3): 308–313.
15. Kaur J, Singh P. Pudendal nerve entrapment syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2020.
16. Probst D, Stout A, Hunt D. Piriformis syndrome: a narrative review of the anatomy, diagnosis, and treatment. PM R 2019; 11(Suppl 1): S54–S63.
17. Hicks BL, Lam JC, Varacallo M. Piriformis Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2020.
18. Moroni S, Zwierzina M, Starke V, et al. Clinical-anatomic mapping of the tarsal tunnel with regard to Baxter’s neuropathy in recalcitrant heel pain syndrome: part I. Surg Radiol Anat 2019; 41(1): 29–41.
19. Hollinshead WH. Anatomy for Surgeons. Volume 2. The Thorax, Abdomen and Pelvis. London: Cassell & Co. Ltd. 1956; 636–638.
20. Williams AF. The formation of popliteal vein. Surg Gyn Obstet 1953; 99: 769–772.
21. Mahadevan V. Pelvic girdle and lower limb. In: Standring S. (ed.) Gray’s Anatomy, 40th ed. New York: Elsevier 2008; 1327–1429.
22. Anloague PA, Huijbregts P. Anatomical variations of the lumbar plexus: A descriptive anatomy study with proposed clinical implications. J Man Manip Ther 2009; 17: e107–e114.
23. Aasar YH. Anatomical Anomalies. Cairo: Fouad I University Press 1947; 92–101.
24. Sim IW, Webb T. Anatomy and anaesthesia of the lumbar somatic plexus. Anaesth Intensive Care 2004; 32: 178–187.
25. Caraj A, Fenu G, Sechi E, et al. Anatomical variability of the lateral femoral cutaneous nerve: Findings from a surgical series. Clin Anat 2009; 22: 365–370.
26. Spratt JD, Logan BM, Abrahams PH. Variant slips of psoas and iliacus muscles, with splitting of the femoral nerve. Clin Anat 1996; 9: 401–404.
27. Locher S, Burmeister H, Bohlen T, et al. Radiological anatomy of the obturator nerve and its articular branches: basis to develop a method of radiofrequency denervation for hip joint pain. Pain Med 2008; 9(3): 291–298.
28. Akkava T, Comert A, Kendir S, et al. Detailed anatomy of accessory obturator nerve blockade. Minerva Anestesiol 2008; 74: 119–122.
29. Webber RH. Some variations in the lumbar plexus of nerves in man. Acta Anat 1961; 44: 336–345.
30. Eisler P. Der Plexus lumbosacralis des Menschen. Berlin: Halle 1892.
31. Jacobs LGH, Buxton RA. The course of the SGN in the lateral approach to the hip. J Bone Joint Surg (Am) 1989; 71A: 1239–1243.
32. Apaydin N, Kendir S, Loukas M, et al. Surgical anatomy of the superior gluteal nerve and landmarks for its localization during minimally invasive approaches to the hip. Clin Anat 2013; 26(5): 614–620.
33. Beaton LE, Anson BJ. The relation of the sciatic nerve and its subdivisions to the piriformis muscle. Anat Rec 1938; 70: 1–5.
34. Patel S, Shah M, Vora R, et al. A variation in the high division of the sciatic nevre and its relation with piriformis syndrome. National J Med Res 2011; 1(2): 27–30.
35. Ricci S, Moro L, Antonelli Incalzi R. Ultrasound imaging of the sural nerve: ultrasound anatomy and rationale for investigation. Eur J Vasc Endovasc Surg 2010; 39(5): 636–641.
36. Belsack D, Jager T, Scafoglieri A, et al. Ultrasound of the sural nerve: normal anatomy on cadaveric dissection and case series. Eur J Radiol 2013; 82(11): 1953–1958.
37. Garagozlo C, Kadri O, Atalla M, et al. The anatomical relationship between the sural nerve and small saphenous vein: An ultrasound study of healthy participants. Clin Anat 2019; 32(2): 277–281.
38. Rodriguez-Acevedo O, Elstner K, et al. The sural nerve: Sonographic anatomy, variability and relation to the small saphenous vein in the setting of endovenous thermal ablation. Phlebology 2017; 32(1): 49–54.
39. Popieluszko P, Mizia E, Henry BM, et al. The surgical anatomy of the sural nerve: An ultrasound study. Clin Anat 2018; 31(4): 450–455.
40. Zhu J, Li D, Shao J, Hu B. An ultrasound study of anatomic variants of the sural nerve. Muscle Nerve 2011; 43: 560–562.
41. Ramakrishnan PK, Henry BM, Vikse J, et al. Anatomical variations of the formation and course of the sural nerve: A systematic review and meta-analysis. Ann Anat 2015; 202: 36–44.
42. Eid EM, Hegazy AM. Anatomical variations of the human sural nerve and its role in clinical and surgical procedures. Clin Anat 2011; 24: 237–245.
43. Amoiridis G, Schols L, Ameridis N, Przuntek H. Motor fibers in the sural nerve of humans. Neurology 1997; 49: 1725–1728.
44. Piersol GA. Human Anatomy. Philadelphia: Lippincott Company 1916.
45. Yi SQ, Itoh M. A unique variation of the pudendal nerve. Clin Anat 2010; 23(8): 907–908.
46. Roztočil K, Piťha J, a kol. Nemoci končetinových cév. 2. vydání. Praha: Mladá fronta 2021; 20–121.
47. Kachlík D, Pecháček V, Báča V, Musil V. The superficial venous system of the lower extremity: new nomenclature. Phlebology 2010; 25(3): 113–123.
48. Kachlík D, Pecháček V, Musil V, Báča V. The venous system of the pelvis: new nomenclature. Phlebology 2010; 25(4): 162–173.
49. Kachlík D, Pecháček V, Musil V, Báča V. The deep venous system of the lower extremity: new nomenclature. Phlebology 2012; 27(2): 48–58.
50. Caggiati A, Bergan JJ, Gloviczki P, et al. Nomenclature of the veins of lower limb: An International Interdisciplinary consensus statement. J Vasc Surg 2002; 36: 416–422.
51. Caggiati A, Bergan JJ, Gloviczki P, et al. Nomenclature of the veins of lower limb: Extensions, refinements, and clinical application. An international interdisciplinary consensus committee on venous anatomical terminology. J Vasc Surg 2005; 41: 719–724.
52. Coleridge-Smith P, Labropoulos N, Partsch H, et al. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs – UIP consensus document. Part I. Basic principles. Eur J Vasc Endovasc Surg 2006; 31(1): 83–92.
53. Schweihofer G, Mühlberger D, Brenner W. The anatomy of the small saphnous vein: Fascial and neural relationsm saphenofemoral junction, and valves. J Vasc Surg 2010; 51(4): 982–989.
54. Quain R. The anatomy of the arteries of the human body and its application to pathology and operative surgery. London: Taylor and Walton 1844.
55. Dwight T. Statistics of variations with remarks on the use of this method in anthropology. Anat Anz 1894–1895; 10: 209–215.
56. Veverková L, Kalač J, Páč L. Nervus saphenus a jeho vztah k vena saphena magna. Brno: Masarykova univerzita 2002.
57. Staubesand J. Die Perforanten-Trias: Ein funktionelles System. Phlebologie 1994; 23: 447–458.
Labels
General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
2022 Issue 5
Most read in this issue
- Anatomy of the venous and nervous system of the lower limb
- Clean intermittent catheterization of the urinary bladder
- Eating preferences of university students in connection with their body composition
- Education of General Practicioners at Slovak Medical University in Bratislava