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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
It ascends behind and lateral to the corresponding arter y to join the external iliac vein. It is duplicated in some 30% of subjects, and if so then one trunk receives blood from visceral tributaries and the other from parietal tributaries (Figure 2.10).Parietal tributaries from outside the pelvis are the superior and inferior gluteal veins that drain gluteal muscles, and the obturator vein that drains medial thigh muscles. The obturator vein may be replaced by an accessor y obturator vein that joins the external iliac vein.Parietal tributaries from the walls of the pelvis form the sacral venous plexus behind the rectum, which drains blood from spinal veins through the medial sacral veins into the left common iliac vein, iliolumbar vein into the common iliac veins and lateral sacral vein into the internal iliac veins.Visceral tributaries arise in the rectal, vesical and pudendal plexuses, and the vaginal and uterine or prostatic plexuses. There are extensive connections between the plexuses and, through them, between the inferior and superior vena cavae.External and internal rectal venous plexuses lie within the rectal wall. The internal rectal plexus forms the haemorrhoidal plexus and drains both cranially through the superior rectal veins to the inferior mesenteric vein in the portal circulation, and through the middle rectal veins and internal pudendal vein to the internal iliac vein in the systemic venous circulation.The pudendal plexus lies behind the pubic symphysis in front of the bladder and connects with the internal pudendal vein and is commonly known as the plexus of Santorini.In the female, the uterine plexuses lie along the sides and superior angles of the uterus between the two layers of the broad ligament, the vaginal plexuses are placed at the sides of the vagina, and the ovarian plexuses surround the ovaries. These form a major connection between pelvic veins and the pubic, suprapubic, obturator, inferior epigastric and deep circumflex iliac veins passing to veins in the lower limbs.In the male, the superficial dorsal vein of the penis drains the prepuce and skin of the penis and opens into the external pudendal veins, tributaries of the great saphenous vein. The deep dorsal vein of the penis drains the glans penis and corpora cavernosa and passes to the pudendal plexus behind the symphysis pubis and in front of the bladder and prostate and then to the internal pudendal vein.
Filler-induced non-thrombotic pulmonary embolism after genital aesthetic injection
Published in Journal of Cosmetic and Laser Therapy, 2022
At present, the anatomical mechanism of FINTPE caused by genital injection is not precise. In general, the injury of blood vessels is regarded as the cause (14). For vaginal injection, with abundant vessels and narrow local space in the vagina, it is likely to produce excessive pressure, severe vascular injury, and filler displacement during injection (14,17,20,31). It is supposed that the fillers may be inadvertently injected into the blood vessels through the vaginal wall and drained to the internal iliac vein through the venous plexus on both sides of the vagina and through the uterine vein, bladder venous plexus, and rectal venous plexus. The fillers in the internal iliac vein then enter the inferior vena cava reflux system and reach the right atrium. Finally, the fillers pass through the right atrium and right ventricle and successfully cause embolism by pumping into the pulmonary arteries (15). This process is kind of like the mechanism of the pulmonary embolism caused by buttock augmentation with fat grafting (34,35). We summarized that the mechanism of FINTPE has two elements: 1. There are many blood vessels in anatomical parts, especially thin-walled veins with large blood flow, which largely increases the possibility of vascular damage. 2. Large injection volume within a small injection space leads to excessive local pressure, pushing the emboli to enter the blood vessel.