THE DEEP VEINS OF THE LOWER EXTREMITY 



753 



serves to connect the common iliac, iliolumbar, lumbar, and azygos veins of the 

 corresponding side of the body. 



The spermatic veins (vv. spermaticae) (Fig. 527) emerge from the back of the 

 testis, and receive tributaries from the epididymis; they unite and form a convo- 

 luted plexus called the spermatic plexus (plexus pampiniformis), which constitutes 

 the preater mass of the cord: the vessels composing this plexus are very numerous, 

 and ascend along the cord in front of the vas deferens: below the external abdom- 

 inal rinp they unite to form three or four veins, which pass along the inguinal 

 canal, and, entering the abdomen through the internal abdominal ring, coalesce 

 to form two veins, which asoend on the Psna.s pnnsple behind the peritoneum. 

 lying one on either side of the spermatic artery. These unite to form a single 

 vein, which opens on the right side into the inferior vena cava at an acute angle: 

 on the left side into the fcff, r f ^l vein at a right angle (Fig. 528). The spermatic 



SPERMATIC VEIN _. 

 RIGHT SIDE 



MATIC VEIN- 

 LEFT SIDE 



FIG. 528. Terminations of the right and left spermatic veins. (Poirier and Charpy.) 



veins are provided with valves, particularly at the termination. The left spermatic 

 vein passes behind the sigmoid flexure of the colon, and is thus exposed ro pressure 

 from the contents of that bowel. 



Applied Anatomy. The spermatic veins are very frequently varicose, constituting the dis- 

 ease known as varicocele. Though it is quite possible that the originating cause of this affection 

 may be a congenital abnormality either in the size or number of the veins of the spermatic plexus, 

 still it must be admitted that there are many anatomical reasons why these veins should become 

 varicose viz., the imperfect support afforded to them by the loose tissue of the scrotum ; their 

 great length; their vertical course: their dependent position; their __plexiform arrangement in 

 the scrotum, with their termination in one small vein in the abdomen: their few and imperfect 

 valves; and the fact that they may be subjected tn prpssnrp in tVi^ir paggagg thrnnprh thp ahdmn- 

 inal wall. The left veins more often hprnmp v8irim.se than the right veins, probably, as Brinton 

 suggests, because the right spermatic vein practically always has a valve and opens into the 

 inferior vena cava at an acute angle, whereas the left spermatic vein is not unusually destitute 

 of a^ valve at its opening and passes into the left renal vein at a right angle. 



The operation for the removal of a varicocele consists in making a small incision just over 

 the external abdominal ring and passing an aneurism needle around the mass of veins, taking 

 care that the vas deferens is not included. The veins are isolated from the vas and ligated 

 above and below, as high and as low as possible, and the intermediate portion cut away; the 

 divided ends are fixed together with a suture, and the skin wound closed. 



48 



