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Anatomy of veins and lymphatics
Published in Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland, Manual of Venous and Lymphatic Diseases, 2017
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland
The posterior tibial veins arise from the medial and lateral plantar veins and drain the posterior compartment of the leg and plantar surface of the foot. Peroneal veins drain the deep compartment. Anterior tibial veins arise from dorsal veins of the foot and pass along the anterior compartment of the leg and through the proximal interosseous membrane below the knee.
Development and anatomy of the venous system
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
In the calf, the paired posterior tibial veins run between the edges of the flexor digitorum longus and tibialis posterior muscles and under the fascia of the deep posterior compartment (Figure 2.10). They drain the muscles of the deep and superficial posterior compartments and are connected to the GSV and posterior accessory saphenous vein by perforators. The posterior tibial veins pierce the soleus muscle close to its bony adherence (soleal arcade) and continue into the popliteal vein. The anterior tibial veins ascend in the anterior compartment. Distally, there is a constant connection between the anterior tibial and the peroneal veins. The peroneal veins originate in the distal third of the calf and ascend deep to the flexor hallucis longus muscle. They receive the peroneal perforators and several large veins from the soleus muscle. The anterior tibial and peroneal veins form the short tibio-peroneal trunk, which joins the posterior tibial veins to form the popliteal vein.
Practical guide for deep venous patency and obstruction
Published in Joseph A. Zygmunt, Venous Ultrasound, 2020
The calf veins are primarily paired veins associated with a calf artery [9]. The posterior tibial veins (PTV) arise in the posterior-medial ankle and follow a course that is posterior to the tibia in the calf and terminates in the tibioperoneal trunk. The anterior tibial veins (ATV) arise from the anterior-lateral aspect of the ankle and follow a course that is anterior-lateral to the tibia, terminating in the popliteal vein just below the level of the knee. The peroneal veins (PER V) arise from the posterior-lateral ankle and take a deep course near the fibula. The PTV, ATV, and PER V are paired veins and are associated with an artery with which they share a name [10,11]. The confluence of the PTV and PER V at the level of the proximal calf forms the tibioperoneal trunk. The ATV joins the tibioperoneal trunk in the proximal calf forming the popliteal vein (POP V). The venous sinusoids in the deep calf musculature merge to form the gastrocnemius and soleal plexus. There are anywhere from 1 to 18 soleal vein connections to the PTV, with the most proximal being the most visible and vital for the evaluation of venous thrombosis [9]. The soleal vein is short, and it can be mistaken for a perforating vein, with the difference being that the soleal vein remains in the deep system draining the soleus muscle to the posterior tibial vein (Figure 5.2). The gastrocnemius veins, which are paired veins, are located in the posterior calf and drain into the POP V. They are associated with the gastrocnemius artery [9,11] (Figure 5.3). It is common to see the gastrocnemius veins occurring in multiples of two. The gastrocnemius veins and soleal veins are common sites of the DVT in the calf, making them an essential part of a complete lower extremity venous duplex exam [12,13].
Central Venous Catheter as a Novel Approach to Postoperative Thrombolysis in Patients with Acute Iliofemoral Deep Venous Thrombosis
Published in Clinical and Experimental Hypertension, 2023
Biyun Teng, Fenghe Li, Xuehu Wang, Hao Tian, Yu Zhao, Qiu Zeng
All venous access was established in the vessels below the knee (BTK), including in the proximal posterior tibial vein (PPTV), anterior tibial vein (ATV), distal posterior tibial vein (DPTV), and peroneal vein (PeV), to sufficiently facilitate thrombi removal during the procedures and maintain patient comfort and ambulatory care after the procedures (Figure 1). Venous access was obtained through four approaches: ultrasound-guided puncture, crossover guidewire- or roadmap-guided puncture, great saphenous vein roadmap-guided puncture, or fluoroscopic image of tibial bone-guided puncture. Twenty-one gauge microneedles with associated microwires and introducers (COOK, USA) were used in all punctures. A 10 French vascular sheath (Cordis, USA) was introduced to accommodate the aspiration catheter, and stents with different sizes were placed to manage iliac vein compression.
Pharmacological thrombolysis: the last choice for salvaging free flaps
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Sik Namgoong, Jong-Phil Yang, Seong Ho Jeong, Seung Kyu Han, Woo Kyung Kim, Eun Sang Dhong
A 54-year-old woman underwent ALT free flap transfer for chronic osteomyelitis in the left anterior tibial area. The descending branch of the lateral circumflex femoral artery was anastomosed to the left anterior tibial artery. A single venorrhaphy was performed with the anterior tibial veins and vena comitans. Within 24 h, the flap became hyperemic with accelerated capillary refilling, warm temperature, and positive Doppler sound. At 36 h, the distal flap margin appeared purple and congested overall. Surgical exploration of the anastomotic site showed intact arterial and venous blood flow without discernable thrombosis. Intact circulatory flow at the venorrhaphy site was confirmed by milking test; however, venous flow was sluggish. Based on our salvaging algorithm, we could attribute the sluggish venous outflow to internal causes such as arterial spasm, perforasome selection issues (i.e. extremely large flap territory for the area perfused by the perforator) [12,13], and intra-flap microthrombosis. At this point, we attempted to apply topical papaverine and lidocaine to the anastomotic site to rule out the abovementioned internal causes; however, venous return did not recover.