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Cardiovascular System: Circulation

CARDIOVASCULAR SYSTEM: CIRCULATION

CHAPTER OBJECTIVES
When you have completed this chapter you should be able to:
  • Describe the difference between the systemic, pulmonary and portal circulation.
  • Describe the difference between an artery and a vein.
  • Identify the major arteries of the body.
  • Identify the major veins of the body.
  • Trace the major route of blood from the heart to the limbs.
  • Identify the major pulse points.
  • Understand blood pressure.

Structure of Blood Vessels

Oxygenated blood from the heart is circulated around the whole body via a network of arteries. The heart must pump the blood out of the heart at high pressure to push it through the system of arteries which supply the entire body. The arterial walls reflect this by being strong and muscular to resist this surge of high blood pressure.

Deoxygenated blood is returned to the heart via a network of veins. By the time the blood gets into the vascular system the blood pressure has greatly reduced. The venous walls reflect this by being thin and flaccid as they do not experience the same surges of high blood pressure.

Blood vessel walls

The walls of the arteries have a slightly different structure to those of the veins, however they both consist of the same three layers (tunica).

Wall Layers Description Arteries Veins Function
Tunica adventitia Outer coat consisting of loose collagen and elastin fibres.   The adventitia anchors the vessel in place. It provides a route for nerves and vessels to the vessel wall itself.
Tunica media Middle layer consisting of smooth muscle, collagen and elastin. Thickest layer of an artery wall. Thin. The media protects the vessel from rupture by resisting the effects of blood pressure. It also allows the vessel to vasoconstrict and vasodilate.
Internal elastic lamina A single layer of elastic fibres. Only found in arteries. None. Allows the vessel to recoil after it is stretched in systole.
Tunica intima A smooth layer of endothelial cells on a basement membrane. Thin. Thin. The intima forms a smooth surface for the blood to flow past. It also prevents blood from sticking to the arterial/venous wall surface.
External elastic lamina A single layer of elastic fibres. Only found in arteries. None. Allows the vessel to recoil after it is stretched in systole.
Lumen The hole in which the blood passes. Circular; in arteries the lumen retain their shape even when empty. Flaccid; in veins the lumen does not retain their shape when empty. Provides a channel for the blood.

Arteries

Arteries carry blood away from the heart. They begin as large conducting vessels such as the aorta, common carotid and common iliac arteries. Both the aorta and pulmonary trunk are conducting vessels which arise directly from the left and right ventricles of the heart respectively. The conducting arteries have the thickest muscular walls (tunica media) and expand when ventricles are squeezing blood into them, recoiling when the ventricles relax.

The conducting arteries divide and give off smaller 'named' distributing arteries which travel to specific parts of the body. The distributing arteries divide into smaller unnamed branches until eventually dividing into tiny arterioles which further divide into minute capillaries. As the arteries get smaller the relative thickness of the tunica media also decreases.

The capillaries join together to form a capillary network; it is in this network where the nutrients from the blood are exchanged into the surrounding tissues.

Veins

Veins carry blood towards the heart. Venules, the minute beginnings of the veins emerge from the capillary network. Like the capillaries the venules form a network; it is in this network that waste products from the surrounding tissues are absorbed into the blood. The venules join together to form small unnamed veins which join together to form the larger 'named' veins.

A number of these named veins possess semilunar valves to prevent the blood from flowing backwards in the wrong direction. These larger veins eventually converge to form the large superior and inferior vena cavae which empty into the right atrium of the heart.

SELF-TEST
Complete the following questions before you go onto the next section:
  • Describe the five types of artery.
  • Which type of vessels carry blood away from the heart?
  • Name the three tunica that make up a vessel wall.

Circulation

The circulation of blood can be described in three parts;

Pulmonary circulation

The pulmonary circulation functions to get rid of the waste product carbon dioxide from the blood and to saturate the blood with oxygen. The cycle begins when deoxygenated blood is pushed from the right ventricle into the pulmonary trunk. The pulmonary trunk soon divides into two large pulmonary arteries, left and right. These arteries are the only arteries in the body that carry deoxygenated blood. The right pulmonary artery enters the hilum of the right lung and divides into 3 lobular arteries to the 3 lobes of the right lung. The left pulmonary artery enters the hilum of the left lung and divides into 2 lobular arteries to the 2 lobes of the left lung. The lobular arteries continue to divide until they become a fine network of capillaries surrounding the tiny alveoli. It is here where gas exchange takes place, and CO2 is released from the blood and O2 is taken into the blood. From here, the now oxygenated blood is carried back to the heart by venules which continually unite to eventually exit each lung as two pulmonary veins; superior and inferior. The 4 pulmonary veins drain into the left atrium which squeezes the oxygenated blood into the left ventricle where it is pushed into the systemic circulation. These veins are the only veins in the body that carry oxygenated blood.

Vessels in order Description
Right ventricle The right ventricle pushes deoxygenated blood into the pulmonary trunk.
Pulmonary trunk The pulmonary trunk quickly divides into left and right pulmonary arteries.
Pulmonary arteries (left and right) The left and right pulmonary arteries enter the hilum of each lung and divide into lobular arteries.
Lobular arteries The lobular arteries continue to divide until they become a fine network of capillaries.
Capillaries The capillaries surround the tiny alveoli and it is here where gas exchange takes place.
Venules Oxygenated blood begins its return journey to the heart.
Pulmonary veins Emerging from each lung hilum are two pulmonary veins; left superior, left inferior, right superior and right inferior pulmonary veins. The enter the left atrium.
Left atrium The left atrium squeezes the oxygenated blood into the left ventricle where it is pushed into the systemic system.

Portal circulation

The portal circulation or 'hepatic portal system' functions to filter the deoxygenated but nutrient rich blood received from the digestive system of toxins and bacteria before it is distributed to the rest of the body. The liver receives venous blood from the oesophagus, stomach, small and large intestines, gallbladder, pancreas and spleen via the large portal vein. On reaching the liver the portal vein divides into two large branches (left and right), which enter the liver and continually branch to form hepatic sinusoids within all of the lobes of the liver. Superiorly the hepatic sinusoids unite to form the hepatic veins which exit the liver from its posterior side and enter the inferior vena cava. From the inferior vena cava the blood is transported to the right atrium where it enters into the pulmonary circulation.

Vessels in order Description
Deoxygenated, nutrient rich blood is received from the oesophagus, stomach, small intestine, large intestine, gallbladder, pancreas and spleen.
Portal The gastric, splenic, mesenteric and gastroepiploic veins all drain into the portal vein which ascends to the liver.
Left & right portal On reaching the liver the portal vein divides into left and right portal veins which enter the liver.
Hepatic sinusoids The portal veins continually branch to form hepatic sinusoids within all of the lobes of the liver.
Hepatic The hepatic sinusoids unite to form the hepatic veins, which exit the liver posteriorly to enter the inferior vena cava.
Inferior vena cava The inferior vena cava transports the blood to the right atrium.
Right atrium The right atrium squeezes the blood into the right ventricle where it is pushed into the pulmonary circulation.
SELF-TEST
Complete the following questions before you go onto the next section:
  • The portal vein drains which structures?
  • What is the function of the portal circulation?
  • What do the hepatic sinusoids unite to form ?

Systemic circulation

The systemic circulation functions to deliver oxygenated blood and remove the waste products from all of the tissues in the body. The cycle begins when oxygenated blood is pushed from the left ventricle into the ascending aorta. From here the aorta arches over the heart and descends into the thorax and abdomen giving rise to all of the systemic arteries. These arteries continually divide until they form a network of capillaries that surround all of the tissues of the body. It is here where gas exchange takes place; O2 is released from the blood and CO2 is taken into the blood. The now deoxygenated blood begins its journey back to the heart in a network of tiny venules. The venules continually unite to form small veins and then large veins. These large veins eventually empty into the superior and inferior vena cava which delivers the deoxygenated blood to the right atrium where it is then circulated around the pulmonary system.

ARTERIES

Aorta

The aorta is the largest artery in the body and is the source of all of the systemic arteries. It arises from the left ventricle of the heart, arches backwards over the heart and descends through the thorax and abdomen where it eventually divides into the common iliac arteries.

Because of its size the aorta is described in 4 parts;

AORTA Description Branches
Ascending aorta The short ascending aorta leaves the left ventricle and travels upwards to continue as the arch of the aorta.
Arch of the aorta The arch of the aorta arches backwards and to the left over the heart to continue as the descending thoracic aorta.
  • Brachiocephalic trunk.
  • Left common carotid.
  • Left subclavian.
Descending Thoracic aorta The descending thoracic aorta travels down through the thorax, on the left of the vertebral column, until the aortic aperture of the diaphragm (T12) where it continues as the abdominal aorta.
  • Bronchial.
  • Oesophageal.
  • Posterior intercostal.
  • Subcostal.
Descending Abdominal aorta The descending abdominal aorta descends through the abdomen from the aortic aperture of the diaphragm, until it reaches the fourth lumbar vertebrae where it divides into the common iliac arteries.
  • Phrenic.
  • Celiac trunk.
  • Renal.
  • Middle suprarenal
  • Superior mesenteric.
  • Ovarian/testicular.
  • Inferior mesenteric.
  • Common iliac.
Main Branches of the Aorta
NAME Description Branches
Coronary (left right) Arising from the ascending aorta just above the cusps of the aortic valve, they pass in the coronary grooves between the atria and ventricles to supply the heart muscle itself.
  • Interventricular.
  • Marginal.
  • Circumflex.
Brachiocephalic trunk Arises from the arch of the aorta, ascends behind the right clavicle where it terminates by dividing into the right common carotid and subclavian arteries which supply the head, neck and right arm.
  • Right common carotid.
  • Right subclavian.
Left common carotid Arises from the arch of the aorta, ascends in the neck to the level of C4 where it divides into the left internal and left external carotid arteries which supply the head and neck.
  • Left internal carotid.
  • Left external carotid.
Left subclavian Arises from the arch of the aorta, travels to the left giving off many branches before passing over the first rib to become the left axillary artery and supply the left arm.
Posterior intercostals They arise from the posterolateral sides of the descending thoracic aorta, and travel to the intercostal spaces which they supply.
  • Collateral.
Celiac trunk Arises just as the aorta passes through the diaphragm, it travels 1cm before dividing into gastric, hepatic and splenic arteries which supply the stomach, liver and spleen.
Middle adrenal (suprarenal) They arise from the sides of the descending abdominal aorta and supply the adrenal glands.  
Renal They are large branches which arise from the sides of the descending abdominal aorta and travel horizontally to supply the kidneys.
  • Inferior suprarenal.
Superior mesenteric Arises from the front of the descending abdominal aorta at the level of L1. It descends into the mesentery where it branches to supply the intestines.
  • Right and middle colic.
  • Ileocolic.
  • Jejunal.
Ovarian/testicular They arise from the sides of the descending abdominal aorta just below the renal arteries. They pass along psoas major to the pelvis where they supply the ovaries in the female. In the male the arteries pass to the inguinal canal and into the spermatic cord to supply the testicles.  
Inferior mesenteric Arises from the front of the descending abdominal aorta at the level of L3. It descends behind the mesentery where it branches to supply the large intestines.
  • Left colic.
  • Sigmoid.
  • Superior rectal.
Common iliac Arise at the level of L4 as a division of the descending abdominal aorta and supplies the the pelvis and lower limb.
SELF-TEST
Complete the following questions before you go onto the next section:
  • Starting with the left ventricle of the heart, list the arteries in which blood travels to the stomach.
  • What do the branches of the inferior mesenteric artery supply?
  • The brachiocephalic artery gives rise to which important branches?

Arteries of the head and neck

The right and left common carotid arteries supply a large proportion of the head and neck with blood. The left common carotid artery emerges from the arch of the aorta and the right from the right subclavian artery. They both ascend at the side of the neck and divide to form the internal and external carotids. At this division is an important swelling, the carotid sinus, which is supplied by sensory fibres of the glossopharyngeal (IX cranial) nerve and functions to control the pressure of the blood travelling into the brain; keeping it constant.

The vertebral arteries are important as they supply the cervical vertebrae, the cerebellum and the spinal cord with blood. They arise from the subclavian arteries and travel to the base of the brain via the holes (transverse foramen) in the transverse processes of the cervical vertebrae and enter the skull via the foramen magnum.

Name Origin Description Branches
Common carotid
  • Arch of aorta
  • Right subclavian
The left arises from the arch of the aorta, and the right from the subclavian vein. They both ascend in the neck to the level of C4 where they branch to supply the head, neck and face.
  • External carotid.
  • Internal carotid.
External carotid
  • Common carotid
A division of the common carotid artery, it ascends to the parotid gland where it divides to supply the face and scalp.
Internal carotid
  • Common carotid
A division of the common carotid artery, it ascends with the internal jugular vein within the carotid sheath to enter the skull via the carotid canal. It divides to supply the cerebrum, eyes, nose and forehead.
Vertebral
  • Subclavian
Branches of the subclavian artery, they ascend the neck through the transverse foramen of the cervical vertebrae and enter the skull via the foramen magnum. Here both sides join together to form the basilar artery which lies on the underside of the midbrain.
  • Spinal.
  • Posterior inferior cerebellar.
  • Basilar.
Basilar
  • Vertebral
Formed by the union of the vertebral arteries, this single mid line vessel on the underside of the brain supplies the cerebellum, pons and inner ear. It is important as it forms the Circle of Willis around the base of the brain.
  • Superior cerebellar.
  • Anterior inferior cerebellar.
  • Posterior cerebral.
The Circle of Willis

The Circle of Willis is formed at the base of the brain by the cerebellar branches of the basilar artery, the internal carotid arteries and the cerebral arteries of the internal carotid artery. The vessels join together via communicating branches to form a circle of anastomosing vessels around the pituitary gland and optic chiasma. This arrangement is very important if one of the vessels becomes occluded or damaged, as it provides an alternative continuous blood supply to the brain.

SELF-TEST
Complete the following questions before you go onto the next section:
  • Starting with the right subclavian, list the arteries in which blood travels to the face.
  • Why is the circle of Willis so important?
  • Describe the route of the vertebral arteries?

Arteries of the upper limb

The blood supply to the upper limbs is derived from branches of the subclavian arteries. The left subclavian artery arises directly from the arch of the aorta, and the right subclavian artery arises from the brachiocephalic trunk. Both subclavian arteries travel laterally towards the shoulder and pass under the clavicles. Once they pass over the lateral border of the first rib the arteries are renamed the axillary arteries. The axillary arteries pass through the axilla (armpit) giving off branches to the shoulder joint. They are renamed the brachial arteries as they pass under teres minor and descend into the arm. The brachial arteries descend along the medial side of the arm supplying the flexors of the arm. It divides in the front of the elbow to become the radial and ulnar arteries. The ulnar artery passes along the ulnar (medial) side of the arm to the wrist where it forms the superficial palmar arch. The radial artery passes along the radial (lateral) side of the arm to the wrist where it forms the deep palmar arch. The superficial and deep palmar arches anastomose, and give rise to the digital arteries which supply the thumb and fingers.

Name Origin Description Branches
Subclavian
  • Brachiocephalic trunk (right) Arch of aorta (left)
The whole of the upper limb is supplied by branches of this vessel. It arises on the right from the brachiocephalic and on the left form the arch of the aorta. They pass laterally to terminate as they pass over the lateral border of the first ribs, where they become the axillary arteries.
Axillary
  • Subclavian
A continuation of the subclavian artery as it passes over the lateral border of the first rib. It travels through the axilla and becomes the brachial artery as it passes under teres minor.
  • Circumflex humeral.
  • Brachial.
Brachial
  • Axillary
A continuation of the axillary artery as it passes under teres minor. It runs along the medial side of the arm until it reaches the front of the elbow (cubital fossa) where it divides into the radial and ulnar arteries.
  • Radial.
  • Ulnar.
Ulnar
  • Brachial
It arises in the cubital fossa as a division of the brachial artery and passes along the medial side of the forearm to the wrist where it forms the superficial palmar arch. The arch anastomoses with the deep palmar arch and together they supply the digits.
Radial
  • Brachial
It arises in the cubital fossa as a division of the brachial artery and passes along the lateral side of the forearm to the wrist, where its pulse can be easily felt. It passes into the palm where it forms the deep palmar arch. The arch anastomoses with the superficial palmar arch and together they supply the digits.
SELF-TEST
Complete the following questions before you go onto the next section:
  • Starting with the arch of the aorta, list the arteries in which blood travels to the palm of the hand.
  • Which arteries form the deep and superficial palmar arches?
  • Which artery travels through the axilla?

Arteries of the lower limb

The blood supply to the lower limbs is derived from the common iliac arteries, which are a direct continuation of the descending abdominal aorta. The common iliac arteries are short and soon divide into internal and external iliac arteries. The internal iliac arteries divide into anterior and posterior trunks which supply the gluteal region (buttocks) the pelvic muscles and the external genitalia. The external iliac arteries and its branches supply the entire lower limb. It passes along the medial edge of psoas major to pass underneath the inguinal ligament where it is renamed the femoral artery. The femoral artery travels through the femoral triangle on the front of the thigh, leaving it via its apex to reach the adductor canal where it is surrounded by the adductor muscles. The femoral artery leaves the adductor canal via the adductor hiatus in adductor magnus to enter the back of the knee (popliteal fossa) as the popliteal artery. The popliteal artery passes through the popliteal fossa and divides into the anterior and posterior tibial arteries. The anterior tibial artery descends through the leg on the front of the interosseous membrane. On reaching the ankle joint it becomes the dorsalis pedis artery which supplies the dorsum (top) of the foot. The posterior tibial artery descends along the back of the leg on top of the tibialis posterior muscle. On reaching the back of the ankle it splits into medial and lateral plantar arteries which travel into the sole (plantar aspect) of the foot which they supply.

Name Origin Description Branches
Common iliac
  • Abdominal aorta
Formed at the level of L4 by the division of the abdominal aorta, they run either side of the sacral promontory where they divide to form the internal and external iliac arteries.
  • Internal iliac.
  • External iliac.
Internal iliac
  • Common iliac
A division of the common iliac, it descends posteriorly and divides into anterior and posterior trunks before giving off branches to the pelvis, perineum and gluteal region.
External iliac
  • Common iliac
A division of the common iliac it descends anteriorly, medial to psoas major, to pass under the inguinal ligament where it becomes the femoral artery to supply the lower limb.
  • Femoral.
Femoral
  • External iliac
Arises in the femoral triangle as a continuation of the external iliac as it passes under the inguinal ligament. It descends in the adductor canal of the thigh and terminates by passing through the adductor hiatus to enter the popliteal fossa (back of the knee) where it becomes the popliteal artery.
Popliteal
  • Femoral
Arises as a continuation of the femoral artery as it passes through the adductor hiatus in adductor magnus, it passes through the popliteal fossa and divides into anterior and posterior tibial arteries to the leg.
  • Anterior tibial.
  • Posterior tibial.
Anterior tibial
  • Popliteal
A division of the popliteal artery, it descends through the leg on the front of the interosseous membrane. On reaching the ankle it becomes the dorsalis pedis artery, which supplies the top of the foot.
  • Dorsalis pedis.
Posterior tibial
  • Popliteal
A division of the popliteal artery, it runs down the back of the leg and across the ankle to supply the sole of the foot.
Dorsalis Pedis
  • Anterior tibial
A continuation of the anterior tibial artery, it crosses the ankle joint, medial to extensor hallucis longus. On reaching the 1st metatarsal space it divides into the arcuate and 1st metatarsal arteries.

Clinical Considerations

Pulse Each time the heart beats the left ventricle pumps blood into the ascending aorta at high pressure. The aorta and the rest of the arteries following on from it are already filled with blood and must therefore stretch to accommodate the new input of blood. Once the left ventricle has stopped contracting the walls of the arteries recoil and help to push the blood around the body.

It is this stretching and recoiling of the arteries as the heart beats that can be felt as a pulse, in the large arteries located close to the skin. The pulse can be used to monitor the rate at which the heart is beating; usually at rest an adult heart beats 60-70 times a minute.

Blood Pressure Blood pressure is the force that the blood pushes on the walls of the blood vessels when the heart beats and when it is at rest. The pressure is highest in your arteries and lowest in your veins.

It reaches its highest when the left ventricle is pushing blood into the aorta which is known as systolic pressure, and reaches its lowest when the ventricles are relaxed, known as diastolic pressure. When blood pressure is measured it is recorded using two numbers to represent the systolic and diastolic pressures, which in a healthy person should be 120/80mg Hg (120 over 80)

It is normal for your blood pressure to fluctuate and can increase when active or excited. Some people suffer with continuous high blood pressure (hypertension), the cause unknown, which can go undetected for years as it generally does not show any symptoms. Other people suffer with high blood pressure as part of another condition they have such as diabetes or kidney disease. High blood pressure means that the heart has to work a lot harder and can lead to a large number of adverse affects including stroke, heart disease and kidney disease. Unusually low blood pressure (hypotension) can also cause problems such as fainting and dizziness and should be investigated in case there is an underlying cause.

SELF-TEST
Complete the following questions before you go onto the next section:
  • Starting with the abdominal aorta, list the arteries in which blood travels to the sole of the foot.
  • What do the branches of the internal iliac supply?
  • Which artery travels through the adductor canal and hiatus?

VEINS

Veins return the deoxygenated blood from the body back to the heart. Their route is more variable than that of the arteries and they tend to anastomose (join with other vessels) to create complex networks. Veins can be described as being deep or superficial. The superficial veins form a variable network in the the subcutaneous fat just below the skin. The deep veins lie deeper and usually follow the arteries of the same name.

Veins of the head and neck

Blood from the brain, scalp and face all drain into the internal jugular veins which can be found either side of the neck under sternocleidomastoid. The internal jugular vein unites with the subclavian vein to form the brachiocephalic vein which drains into the superior vena cava. Blood from the parotid gland, base of the skull, maxilla and neck all drain into the external jugular veins which can be found either side of the neck on top of the sternocleidomastoid muscle. The external jugular vein drains into the subclavian vein. The superior vena cava receives blood from the head, neck, upper limb and breast. It is formed by the union of the two brachiocephalic veins and drains blood into the right atrium.

Name Origin Description Drains into
Venous sinuses
  • Cerebral
The venous sinuses drain the cerebrum via the cerebral veins. The sinuses occur in the cranial cavity between the arachnoid and dura mater. The major ones are the superior sagittal, inferior sagittal, cavernous, sigmoid and transverse sinuses. They terminate by draining into the internal jugular veins.
  • Internal jugular.
Internal jugular It descends in the neck under sternocleidomastoid, receiving the facial and superficial temporal veins. It terminates posterior to the clavicle where it unites with the subclavian vein to form the brachiocephalic vein.
  • Brachiocephalic.
External jugular Arising just below the parotid gland by the union of the posterior auricular and retromandibular veins, it descends superficially along the side of the neck, on top of sternocleidomastoid, and terminates by draining into the subclavian vein.
  • Subclavian.
Subclavian
  • Axillary
The axillary vein becomes the subclavian vein as it passes over the lateral border of the 1st rib. It passes underneath the clavicle where it unites with the internal jugular vein to form the brachiocephalic vein.
  • Brachiocephalic.
Brachiocephalic
  • Internal jugular
  • Subclavian
Formed behind the clavicle by the union of the internal jugular and subclavian veins, it descends behind the sternum where it unites with the brachiocephalic vein from the opposite side to form the superior vena cava.
  • Superior vena cava.
Superior vena cava
  • Brachiocephalic
The left and right brachiocephalic veins unite behind the sternum to form the superior vena cava. The superior vena cava drains directly into the superior aspect of the right atrium of the heart.
  • Right atrium.
SELF-TEST
Complete the following questions before you go onto the next section:
  • Starting with the sigmoid sinus list the veins in which blood is transported to the right atrium.
  • Name the branches which unite to form the external jugular vein.
  • Where does the subclavian vein become the axillary vein?

Veins of the upper limb

Blood from the upper limb is drained by a network of deep and superficial veins. Blood from the deep parts of the hand and forearm is drained into the ulnar and radial veins. At the elbow these veins unite to form the brachial vein which at the shoulder becomes the axillary vein. As the axillary vein passes over the lateral border of the 1st rib it is renamed the subclavian vein which drains into the brachiocephalic vein.

Name Origin Location Description Drains into
Cephalic
  • Dorsal venous plexus.
Superficial It begins at the thumb and travels up the lateral border of the forearm and arm to join the axillary vein in the shoulder.
  • Axillary.
Basilic
  • Dorsal venous plexus.
Superficial It begins on the dorsal aspect of the hand, travels up the medial border of the back of the forearm to become deeper in the arm. On reaching the axilla it unites with the brachial vein to form the axillary vein.
  • Axillary.
Median
  • Superficial palmar venous plexus.
Superficial It travels up the anterior forearm to the elbow where it joins with the cephalic vein.
  • Cephalic.
Axillary
  • Brachial.
  • Basilic.
Deep Formed in the arm by the union of the brachial and basilic veins, it accompanies the axillary artery through the axilla and terminates over the the lateral border of the first rib by becoming the subclavian vein .
  • Subclavian.
Brachial
  • Radial.
  • Ulnar.
Deep Formed at the elbow by the union of the radial and ulnar veins. It is often paired and accompanies the brachial artery to the arm where it joins with the basilic vein to form the axillary vein.
  • Axillary.
Radial
  • Palmar arch.
Deep It arises from the lateral side of the palmar arch, ascends along the radius to the elbow where it terminates by joining with the ulnar vein to form the brachial vein.
  • Brachial.
Ulnar
  • Palmar arch
Deep It arises from the medial side of the palmar arch, ascends along the ulnar to the elbow where it terminates by joining with the radial vein to form the brachial vein.
  • Brachial.
SELF-TEST
Complete the following questions before you go onto the next section:
  • Name the 3 main superficial veins of the upper limb.
  • Starting from the medial side of the palmar arch, list the deep veins in which blood is transported to the left subclavian vein.
  • Which veins unite to form the axillary vein?

Veins of the trunk

Blood is drained from the trunk into the inferior vena cava.

Name Origin Description Drains into
Coronary sinus The veins from the heart muscle itself converge along the coronary groove to form the coronary sinus which opens directly into the right atrium.
Renal veins
  • Kidneys
They emerge from the hila of the kidneys in front of the renal arteries and travel horizontally to drain into the inferior vena cava.
  • Inferior vena cava.
Testicular (male)
  • Testicles
Arising behind each testicle and epididymis, it ascends into the spermatic cord where it forms a pampiniform plexus. The plexus merges to give rise to a single vessel which emerges from the deep inguinal ring and ascends on psoas major. The left vessel drains into the inferior vena cava and the right drains into the right renal vein.
Ovarian (female)
  • Ovaries.
Arising in the broad ligament as a plexus around each ovary. The plexus merges to give rise to a single vessel which ascends on psoas major. The left vessel drains into the inferior vena cava and the right drains into the right renal vein.
  • Inferior vena cava.
  • Right renal.
Hepatic veins
  • Liver
They originate in the liver as intralobular and then sublobular veins. The sublobular veins unite to form the hepatic veins which emerge from the back of the liver to drain into the inferior vena cava.
  • Inferior vena cava.
Inferior vena cava Formed in the abdomen at the level of L5 by the union of the right and left common iliac veins, it ascends the abdomen and thorax to the right of the abdominal aorta and terminates by draining into the inferior aspect of the right atrium.
SELF-TEST
Complete the following questions before you go onto the next section:
  • The inferior vena cava originates at which level from the union of which two vessels?
  • Name the plexus that the testicular veins form in the spermatic cord.
  • Which renal vein is the longer?

Veins of the lower limb

Blood from the lower limb is drained by a network of deep and superficial veins. Blood from the deep parts of the sole of the foot is drained by the medial and lateral plantar veins which unite at the back of the ankle to form the posterior tibial vein. Blood from the deep parts of the dorsum of the foot is drained by the dorsalis pedis vein which becomes the anterior tibial vein as it passes into the ankle. The anterior and posterior tibial veins ascend in the calf to the back of the knee where they unite to form the popliteal vein. This travels through the popliteal fossa until it passes through the adductor hiatus into the anterior thigh where it is renamed the femoral vein. The femoral vein ascends to the groin and passes under the inguinal ligament to become the external iliac vein.

Name Origin Location Description Drains into;
Long Saphenous Vein
  • Dorsal venous arch
Superficial The longest vein the the body, it arises from the medial side of the foot and travels up the medial side of the leg and thigh, to terminate in the femoral triangle, by draining into the femoral vein .
  • Femoral.
Short Saphenous Vein Superficial It arises from the lateral side of the foot and travels up the lateral side of the leg to terminate in the popliteal fossa (back of the knee) by draining into the popliteal vein.
  • Popliteal.
Anterior Tibial Vein Deep A continuation of the dorsalis pedis vein, it arises just above the ankle and accompanies the anterior tibial artery to the popliteal fossa, where it terminates by uniting with the posterior tibial vein to become the popliteal vein.
  • Popliteal.
Posterior Tibial Vein Deep Arises at the back of the ankle by the union of the medial and lateral plantar veins. It accompanies the posterior tibial artery to the popliteal fossa, where it terminates by uniting with the anterior tibial vein to become the popliteal vein.
  • Popliteal.
Popliteal Vein
  • Anterior tibial
  • Posterior tibial
Deep Arises in the popliteal fossa by the union of the anterior and posterior tibial veins. It ascends the back of the knee, passing though the adductor hiatus where it becomes the femoral vein.
  • Femoral.
Femoral Vein
  • Popliteal.
Deep A continuation of the popliteal vein as it passes into the anterior thigh via the adductor hiatus. It accompanies the femoral artery through the thigh to terminate by passing into the pelvis under the inguinal ligament, where it is renamed the external iliac vein.
  • External iliac.
External Iliac Vein
  • Femoral
Deep A continuation of the femoral vein as it passes into the pelvis under the inguinal ligament. It terminates by uniting with the internal iliac vein to form the common iliac veins.
  • Common iliac.
Common Iliac Vein
  • Internal iliac
  • External iliac
Deep Arises in the pelvis from the union of the internal and external iliac veins. It ascends to the level of L5 where it terminates by uniting with the common iliac artery of the opposing side to form the inferior vena cava.
SELF-TEST
Complete the following questions before you go onto the next section:
  • Starting with the dorsal venous arch list the veins in which blood is transported to the right atrium.
  • Name the two main superficial veins in the lower limb.
  • Which vessels unite to form the popliteal vein?
Test your understanding of this chapter with the Interactive QUIZZES and MCQs