744 THE VASCULAR SYSTEMS 



side of the thigh join to form another large vessel; so that occasionally three large 

 veins are seen converging from different parts of the thigh toward the saphenous 

 opening. The internal saphenous vein communicates in the foot with the internal 

 plantar vein; in the leg, with the posterior tibial veins by branches which perforate 

 the tibial origin of the Soleus muscle, and also with the anterior tibial veins; 

 at the knee, with the articular veins ; in the thigh, with the femoral vein by one 

 or more branches. The valves in this vein vary from two to six in number; thev 

 are more numerous in the thigh than in the leg. 



The external or short saphenous vein (v. saphena parva) (Fig. 519) com- 

 mences at the outer side of the arch on the dorsum of the foot; it ascends behind the 

 outer malleolus. and along the outer border of the tendo Achillis, across which it 

 jpasses at an acute angle to reach the middle line of the posterior aspect of the leg. 

 Passing directly upward, it perforates the deep fascia in the lower part of the 

 popliteal space, and terminates in the popliteal vein, between the heads of the 

 Gastrocnemius muscle. It receives numerous large tributaries from the back part 

 of the leg, and communicates with the deep veins on the dorsum of the foot and 

 behind the outer malleolus. Before it perforates the deep fascia it gives off a 

 communicating branch, which passes upward and inward to join the internal 

 saphenous vein. This vein contains from nine to twelve valves, one of which is 

 always found near its termination in the popliteal vein. The external saphenous 

 nerve lies close beside this vein. 



Applied Anatomy. A varicose condition of the saphenous veins is more frequently met 

 with than in the other veins of the body, except perhaps the spermatic and hemorrhoidal veins. 

 The course of the internal saphenous is in front of the tip of the inner malleolus, over the sub- 

 cutaneous surface of the lower end of the tibia, and then along the internal border of this bone 

 to the back part of the internal condyle of the femur, whence it follows the course of the Sar- 

 torius muscle, and is represented on the surface by a line drawn from the posterior border of 

 the Sartorius on a level with the internal condyle to the saphenous opening. The external saph- 

 enous lies behind the external malleolus, and from this follows the middle line of the calf to just 

 below the ham. It is not generally so apparent beneath the skin as the internal saphenous. 

 Both these veins in the leg are accompanied by nerves, the internal saphenous being joined by 

 its companion nerve just below the level of the knee-joint. No doubt much of the pain of vari- 

 cose veins in the leg is due to this fact. 



Operations for the relief of varicose veins are frequently required, portions of the veins being 

 removed after having been ligated above and below. It is important to note whether the main 

 varicose area drains into the internal or the external saphenous vein the former condition 

 being much the more common and to control the venous return by removing a small portion 

 of the main trunk just before it opens into the deep vein by passing through the deep fascia; 

 thus in most cases a piece should be removed from the internal saphenous just before it passes 

 through the saphenous opening, and in addition the affected veins should be excised just above 

 and just below the level of the knee-joint. In other cases the external saphenous will have to 

 be dealt with immediately below the point where it pierces the fascial roof of the popliteal space. 



The Deep Veins of the Lower Extremity. 



The deep veins of the lower extremity accompany the arteries and their branches 

 and are called the venae comites of those vessels. The venae comites in the lower 

 extremity pass into one trunk, the popliteal vein, whereas in the upper extremity 

 the venae comites continue with the artery to the axilla. 



The Deep Veins of the Foot. The plantar digital veins (vv. digitales plantares) 

 form the plantar metatarsal veins (vv. metatarseae plantares), which communicate 

 with the veins of the dorsum of the foot by perforating veins and also communicate 

 with the deep venous arch of the sole of the foot (arcus venosus plaiitaris profundus). 

 The plantar arch gives off lateral or external plantar veins, which unite with median 

 or internal plantar veins to form the posterior tibial veins. On the dorsum of the 

 foot the deep veins begin as the dorsal metatarsal veins (vv. metatarseae dorsales 

 pedis), which form the venae comites of the dorsalis pedis artery. 



