Femoral vein

Femoral vein
Femoral vein shown in the femoral triangle
Images with and without the sartorius muscle, showing the femoral vein and artery beneath
Details
SourcePopliteal, profunda femoris, great saphenous
Drains toExternal iliac vein
ArteryFemoral artery
Identifiers
Latinvena femoralis
MeSHD005268
TA98A12.3.11.023
TA25055
FMA21185
Anatomical terminology

In the human body, the femoral vein is the vein that accompanies the femoral artery in the femoral sheath. It is a deep vein that begins at the adductor hiatus (an opening in the adductor magnus muscle) as the continuation of the popliteal vein. The great saphenous vein (a superficial vein), and the deep femoral vein drain into the femoral vein in the femoral triangle when it becomes known as the common femoral vein. It ends at the inferior margin of the inguinal ligament where it becomes the external iliac vein.[1] Its major tributaries are the deep femoral vein, and the great saphenous vein. The femoral vein contains valves.

Structure

The femoral vein bears valves which are mostly bicuspid and whose number is variable between individuals and often between left and right leg.[1]

Course

Veins of the leg. Common femoral vein shown, in common usage but not listed in TA.

The femoral vein continues into the thigh as the continuation from the popliteal vein at the back of the knee. It drains blood from the deep thigh muscles and thigh bone.[2] Proximal to the confluence with the deep femoral vein, and the joining of the great saphenous vein, the femoral vein is widely known as the common femoral vein.[3] As the common femoral vein leaves the inguinal ligament region it becomes the external iliac vein.[4] Other tributaries of the femoral vein are lateral and medial circumflex femoral veins.

The common femoral vein is the segment of the femoral vein between the branching point of the deep femoral vein and the inferior margin of the inguinal ligament.[5][6] It is not listed in Terminologia Anatomica, which is the international standard for human anatomical terminology developed by the Federative International Programme on Anatomical Terminology. However, it was thought to be due for inclusion in the next edition following consensus documents presented in 2001 at the 14th World Congress of the International Union of Phlebology, and in 2004 at the 21st World Congress of the International Union of Angiology.[7][8] These consensus documents were brought about by the need felt for more clarity and expansion of terms.[9][10]

Distal segment

Segments of the femoral vein.[11]

In the past, the femoral vein was seen to follow the superficial femoral artery a name used to distinguish the femoral artery from the deep femoral artery; as per the norm of naming veins to match their artery the femoral vein was called the superficial femoral vein. This was a potentially harmful misnomer since the femoral vein is a deep vein and not a superficial vein, and thus a possible site for a deep vein thrombosis, that may be overlooked as a superficial vein for anticoagulant therapy.[12]

Because of the widespread misunderstanding, and possible harmful results from the use of superficial femoral vein, a consensus was arrived at in 2001 during the World Congress of the International Union of Phlebology to change the name from superficial femoral vein simply to femoral vein.[13] This has been widely recognised and adopted though the use of superficial femoral vein still persists in some sources. Its use is actively discouraged.[14][15][16] It has been suggested that another term be used – the subsartorial vein.[17][18] A previous usage of subsartorial artery was published to avoid the name superficial femoral vein from being used.[19] As per the consensus of 2002, the superficial femoral artery was unchanged.[20]

Tributaries

The great saphenous vein, and the deep femoral vein are two large tributaries that drain into the femoral vein which then becomes known as the common femoral vein. Other smaller vein tributaries are the lateral and medial circumflex femoral veins.[21] These circumflex veins follow the lateral circumflex femoral artery, and the medial circumflex femoral artery.

Clinical significance

The femoral vein is a common site for a deep vein thrombosis. This can be a proximal DVT in the femoral vein, or more proximal as an iliofemoral DVT usually associated with the common femoral vein. An iliofemoral DVT carries a greater risk of a pulmonary embolism developing.[22]

The femoral vein is often used to place a central venous catheter, or line for venous access. Ultrasound imaging for locating the vein and catheter placement is advocated over the use of anatomical landmarks due to the possible presence of anatomical variants.[23][24][25] This is associated with a significant risk of infection.[25][26]

The practice of delivering recreational drugs intravenously using the femoral vein in the groin, is relatively common amongst injecting drug users.[27]

Additional images

  • Position of femoral vein and artery in adductor canal
    Position of femoral vein and artery in adductor canal
  • Structures surrounding right hip-joint.
    Structures surrounding right hip-joint.
  • Femoral sheath laid open to show its three compartments.
    Femoral sheath laid open to show its three compartments.
  • Femoral vein
    Femoral vein

References

  1. ^ a b Jonas Keiler; Marko Schulze; Host Claassen; Andreas Wree (2018). "Femoral vein diameter, valve and tributary topography in humans - a post mortem analysis". Clinical Anatomy. 31 (7): 1065–1076. doi:10.1002/ca.23224. PMID 30240062. S2CID 52308003.
  2. ^ Saladin, Kenneth S. (2011). Human anatomy (3rd ed.). New York: McGraw-Hill. p. 597. ISBN 9780071222075.
  3. ^ Oh, Geon. "Femoral vein | Radiology Reference Article | Radiopaedia.org". Radiopaedia. Retrieved February 12, 2023.
  4. ^ Lee, DK; Ahn, KS; Kang, CH; Cho, SB (April 2017). "Ultrasonography of the lower extremity veins: anatomy and basic approach". Ultrasonography (Seoul, Korea). 36 (2): 120–130. doi:10.14366/usg.17001. PMC 5381851. PMID 28260355.
  5. ^ Craig Hacking (August 26, 2019). "Common femoral vein". Radiopaedia.
  6. ^ Page 590 in: Reva Arnez Curry, Betty Bates Tempkin (2014). Sonography - E-Book: Introduction to Normal Structure and Function. Elsevier Health Sciences. ISBN 9780323292177.
  7. ^ Kachlik, D; Pechacek, V; Musil, V; Baca, V (March 2012). "The deep venous system of the lower extremity: new nomenclature". Phlebology. 27 (2): 48–58. doi:10.1258/phleb.2011.010081. PMID 21821722. S2CID 26014993.
  8. ^ Kachlik, D; Pechacek, V; Baca, V; Musil, V (June 2010). "The superficial venous system of the lower extremity: new nomenclature". Phlebology. 25 (3): 113–23. doi:10.1258/phleb.2009.009046. PMID 20483860. S2CID 8747016.
  9. ^ Caggiati A, Bergan JJ, Gloviczki P, Jantet G, Wendell-Smith CP, Partsch H; et al. (2002). "Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement". J Vasc Surg. 36 (2): 416–22. doi:10.1067/mva.2002.125847. PMID 12170230.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ^ Kachlik, D; Pechacek, V; Musil, V; Baca, V (March 2010). "Information on the changes in the revised anatomical nomenclature of the lower limb veins". Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia. 154 (1): 93–7. doi:10.5507/bp.2010.016. PMID 20445717.
  11. ^ Amarnath C and Hemant Patel (2023). Comprehensive Textbook of Clinical Radiology - Volume III: Chest and Cardiovascular system. Elsevier Health Sciences. ISBN 9788131263617. Page 1072
  12. ^ Hammond I (November 2003). "The superficial femoral vein". Radiology. 229 (2): 604, discussion 604–6. doi:10.1148/radiol.2292030418. PMID 14595157.
  13. ^ Caggiati, Alberto; Bergan, John J.; Gloviczki, Peter; Eklof, Bo; Allegra, Claudio; Partsch, Hugo (April 1, 2005). "Nomenclature of the veins of the lower limb: Extensions, refinements, and clinical application". Journal of Vascular Surgery. 41 (4): 719–724. doi:10.1016/j.jvs.2005.01.018. PMID 15874941. Retrieved February 12, 2023.
  14. ^ Kitchens CS (2011). "How I treat superficial venous thrombosis". Blood. 117 (1): 39–44. doi:10.1182/blood-2010-05-286690. PMID 20980677. S2CID 250044.
  15. ^ Thiagarajah R, Venkatanarasimha N, Freeman S (2011). "Use of the term "superficial femoral vein" in ultrasound". J Clin Ultrasound. 39 (1): 32–34. doi:10.1002/jcu.20747. PMID 20957733. S2CID 23215861.
  16. ^ Bundens WP, Bergan JJ, Halasz NA, Murray J, Drehobl M (October 1995). "The superficial femoral vein. A potentially lethal misnomer". JAMA. 274 (16): 1296–8. doi:10.1001/jama.1995.03530160048032. PMID 7563535.
  17. ^ Mikael Häggström (2019). "Subsartorial Vessels as Replacement Name for Superficial Femoral Vessels" (PDF). International Journal of Anatomy, Radiology and Surgery: AV01–AV02.
  18. ^ Amarnath C and Hemant Patel (2023). Comprehensive Textbook of Clinical Radiology - Volume III: Chest and Cardiovascular system. Elsevier Health Sciences. ISBN 9788131263617. Page 1072
  19. ^ Antoine Micheau, MD. "Superficial femoral artery". IMAIOS. Retrieved December 22, 2022.
  20. ^ Kupinski, Ann Marie (July 2019). "Venous Nomenclature". Journal of Diagnostic Medical Sonography. 35 (4): 352–353. doi:10.1177/8756479319836983. S2CID 202165116.
  21. ^ "Femoral Vein: Anatomy & Function". Cleveland Clinic. Retrieved February 16, 2023.
  22. ^ Jenkins JS, Michael P (2014). "Deep Venous Thrombosis: An Interventionalist's Approach". Ochsner J. 14 (4): 633–40. PMC 4295740. PMID 25598728.
  23. ^ Saugel, B; Scheeren, TWL; Teboul, JL (August 28, 2017). "Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice". Critical Care. 21 (1): 225. doi:10.1186/s13054-017-1814-y. PMC 5572160. PMID 28844205.
  24. ^ Beno, Suzanne; Nadel, Frances (January 1, 2007), Zaoutis, Lisa B.; Chiang, Vincent W. (eds.), "Chapter 204 - Central Venous Access", Comprehensive Pediatric Hospital Medicine, Philadelphia: Mosby, pp. 1255–1257, doi:10.1016/b978-032303004-5.50208-8, ISBN 978-0-323-03004-5, retrieved November 19, 2020
  25. ^ a b Oram, John; Bodenham, Andrew (January 1, 2009), Treleaven, Jennifer; Barrett, A John (eds.), "CHAPTER 25 - Vascular access", Hematopoietic Stem Cell Transplantation in Clinical Practice, Edinburgh: Churchill Livingstone, pp. 257–266, doi:10.1016/b978-0-443-10147-2.50029-1, ISBN 978-0-443-10147-2, retrieved November 19, 2020
  26. ^ Kern, Winfried V. (January 1, 2017), Cohen, Jonathan; Powderly, William G.; Opal, Steven M. (eds.), "48 - Infections Associated with Intravascular Lines and Grafts", Infectious Diseases (Fourth Edition), Elsevier, pp. 427–438.e3, doi:10.1016/b978-0-7020-6285-8.00048-4, ISBN 978-0-7020-6285-8
  27. ^ Maliphant J, Scott J (April 2005). "Use of the femoral vein ('groin injecting') by a sample of needle exchange clients in Bristol, UK". Harm Reduct J. 2 (1): 6. doi:10.1186/1477-7517-2-6. PMC 1090606. PMID 15833116.