THE VEINS OF THE UPPER EXTREMITY 667 



4. THE SUPERIOR PHRENIC, ANTERIOR MEDIASTINAL, AND 



PERICARDIAC VEINS 



The superior phrenic [vv. phrenicae superiores], the anterior mediastinal [vv mediastinales 

 anteriores], and pericardiac [vv. pericardiacse] veins are small vessels, corresponding to the ar- 

 teries of those names. They pass over the arch of the aorta and open into the lower and an- 

 terior part of the left innominate. 



THE VEINS OF THE UPPER EXTREMITY 



The veins of the upper Hmb consist of two sets — a superficial and a deep. 

 The superficial veins ramify in the subcutaneous tissue above the deep fascia, and 

 they do not accompany arteries. The deep veins accompany the arteries, and 

 have practically the same relations as those vessels. The superficial and deep 

 veins communicate at frequent intervals through the intermuscular veins which 

 run between the muscles and perforate the deep fascia. Both sets of veins are 

 provided with valves, but the valves are more numerous in the deep than in the 

 superficial. There are usually valves where the deep veins join the superficial. 

 The superficial veins are larger than the deep, and take the greater share in 

 returning the blood. 



I. THE SUPERFICIAL VEINS OF THE UPPER EXTREMITY 



The superficial veins begin in two irregular plexuses, one in the palm and the 

 other on the back of the hand. The plexus in the palm is much finer, and com- 

 municates with the superficial volar veins of the fingers. The latter discharge 

 their blood into the dorsal venous rete by means of the veins of the folds between 

 the fingers, or the intercapitular veins [vv. intercapitulares] (fig. 426). 



The veins of the back of the hand begin in a longitudinal plexus over the 

 fingers, and at the bases of the fingers the veins of the adjacent digits are con- 

 nected by digital venous arches [arcus venosi digitales], from which arise the 

 dorsal metacarpal veins [vv. metacarpese dorsales]; these form upon the back 

 of the hand a dorsal venous rete [rete venosum dorsale manus] (fig. 427). 



Of the veins of the arm, two stand out prominently, the basilic and the 

 cephalic. Both of these arise from the veins of the back of the hand, curve 

 around to the volar surface of the forearm, and pass to the upper arm (fig. 426). 



The basilic vein [v. basilica],* arises on the back of the hand from the ulnar 

 end of the dorsal venous rete, which usually forms' an arch. It curves around the 

 ulnar side of the forearm to the volar surface and passes to the elbow and the 

 upper arm, where it lies in the median bicipital sulcus. It extends up to about 

 the middle third of the sulcus, and, piercing the brachial fascia, joins the brachial 

 vein. 



The cephalic vein [v. cephalica],* begins at the radial end of the dorsal 

 venous rete or arch and curves around the radial border of the forearm to the 

 volar surface not far above the thumb. It passes to the elbow and the upper 

 arm, but, unlike the basilic, it maintains its superficial course up to the shoulder, 

 lying first in the lateral bicipital sulcus and then in the groove between the pec- 

 torahs major and the deltoid. Just below the clavicle it turns into the depth, and 

 empties into the axillary vein. 



In the forearm plexus one or more longitudinal veins besides these are usually 

 distinct. One lateral to the cephalic is known as the accessory cephalic [v. 

 cephahca accessorial (formerly the radial) vein; one near the centre is known 

 as the median antibrachial [v. mediana antibrachii], (formerly the anterior 

 ulnar) vein. 



At the elbow there is usually an oblique connecting branch, the median 

 cubital vein [v. mediana cubiti] (formerly termed median basilic) which extends 



* The basilic vein here described corresponds to the posterior ulnar and basilic; the cephalic 

 corresponds to the median, median cephalic and cephalic of the older terminology employed 

 in English text-books. The BNA terminology has the great advantage that it can be readily 

 used to described any form of venous pattern. The English terminologj^ applies only to cases 

 in which the M-shaped arrangement occurs upon the volar surface of the elbow. Berry and 

 Newton find the latter arrangement in only 13 per cent, out of 300 cases examined. 



