THE DEEP VEINS OF THE UPPER EXTREMITY 



735 



VENAE COMITES 

 OF BRACHIAL 

 ARTERY 



spending with the branches of the axillary artery, and terminates immediately 

 beneath the clavicle at the outer border o f the first rib, where it becomes the 

 subclavian vein. This vessel is covered in front by the Pectoral muscles and costo- 

 coracoid membrane, and lies on the thoracic side of the axillary artery, which it par- 

 tially overlaps. Near the lower 

 margin of the Subscapularis 

 it receives the venae comites 

 of the brachial artery, and, 

 near its termination, the ceph- 

 alic vein. This vein is pro- 

 vided with a pair of valves 

 opposite the lower borderof the 

 Subscapularis muscle; valves 

 are also found at the termina- 

 tion of the cephalic and sub- 

 scapular veins. 



Other tributaries of the axil- 

 lary vein are : 



The long thoracic vein (v. 

 thoracalis lateralis) (Fig. 513), 

 which receives the thoracico- 

 epigastric vein (v. thoracoepi- 

 gastrica), and which comes 

 from the superficial epigastric 

 or from the femoral vein; 

 and the costoaxillary veins 

 (vv. costoaxillares) (Fig. 513), 

 which come from the first six 

 intercostal spaces and convey 

 the blood from the intercostal 

 veins to the axillary. 



INTEROSSEOUS 

 VEINS 



ULNAR DEEP 

 VEINS 



ANASTOMOSIS 

 OF RADIAL 

 AND ULNAR 



DIAL DEEP 

 VEINS 



FIG. 511. The deep veins of the upper extremity. (Bourgery.) 



Applied Anatomy. There are 

 several points of surgical interest 

 in connection with the axillary vein. 

 Being more superficial, larger, and slightly overlapping the axillary artery, it is more liable 

 to be wounded in the operation of extirpation of the axillary nodes, especially as these nodes, 

 when diseased, are liable to become adherent to the vessel. When wounded there is always 

 danger of air being drawn into its interior, in which case dedth is usually the result. This 

 is due not only to the fact that it is near the thorax, and therefore liable to be influenced 

 by the respiratory movements, but also because it is adherent by its anterior surface to the 

 costocoracoid membrane, and therefore if wounded is likely to remain patulous and favor the 

 chance of air being sucked in. This adhesion of the vein to the fascia prevents its collapsing, 

 and therefore favors the furious bleeding which takes place in these cases. 



To avoid wounding the axillary vein in the extirpation of nodes from the axilla no undue 

 force should be used in isolating the nodes. If the vein is found to be so embedded in the 

 malignant deposit that the latter cannot be removed without taking away a part of the vein, 

 this must be done, the vessel having been first ligated above and below the diseased area. 



The subclavian vein (y. subclavia} (Figs. 472 and 479), the continuation of the 

 axillary, extends from the outer border of the first rib to the inner end of the clav- 

 icle, where it unites with the internal jugular to form the innominate vein. It is in 

 relation, in front, with the clavicle and the Subclavius muscle; behind and above, 

 with the subclavian artery, from which it is separated internally by the Scalenus 

 anticus muscle and phrenic nerve. Below, it rests in a depression on the first 

 rib and upon the pleura. Above, it is covered by the cervical fascia and integu- 

 ment. 



