Surgical Anatomy of the Veins of the Lower Limb

With the advent of new surgical techniques, such as subfascial endoscopic perforator surgery, venous anatomy of the lower limb gained distinguished attention. Here, based on our surgical experience and observations on several dissections, we describe the embryology and the gross anatomy of the superficial, deep, and perforating veins. The lesser and greater saphenous veins, their named tributaries, such as the posterior arch vein, and numerous unnamed small veins form the superficial venous system. Perforating veins drain the superficial into the deep veins. Incompetent superficial, deep and perforating veins may contribute to chronic venous insufficiency. Clinically the most important perforating veins are located in the medial aspect of the leg at just behind the ankle, at 7 to 9 and 10 to 12 cm from the ankle (Cockett I–III) or they are paratibial at 18 to 22 cm proximal from the ankle (“24”-cm perforator). Deep, axial veins, frequently paired, in the lower limb follow their corresponding arteries.