Anatomical study of the accessory axillary vein

Summary The Accessory Axillary Vein (AAV) was studied in 60 axillae of adult cadavers after fixation in 10% formaldehyde solution. The AAV had an incidence of 56.7% originating in 55.9% from the lateral brachial vein, in 32.4% from the common brachial and in 11.8% from the deep brachial vein. After running upward laterally to the axillary artery and the brachial plexus it ended usually (79.4%) in the suprapectoral portion of the AV. The tributaries of the AAV are the circumflex humeral and muscular veins and rarely the thoraco-acromial and the cephalic veins. The AAV can replace the AV in cases of obliteration of the latter.M.S. thesis in anatomy (LCB Gusmao), Department of Morphology, Escola Paulista de Medicina     

上臂静脉段移植的应用解剖

目的：为采用自体带瓣臂静脉段移植术治疗下肢深静脉功能不全提供解剖学基础。方法：观测４６侧上臂头静脉、贵要静脉及肱静脉外径、瓣膜的数目和分布。结果：各静脉外径均大于３ｍｍ,但头静脉较贵要静脉和肱静脉细。臂中段的静脉瓣膜比臂上、下段多,所有的臂中段都至少有１条适于带瓣移植的静脉段,而在臂上、下段仅分别为７６％和７０％。结论：在臂中段内侧作切口是截取带瓣贵要静脉或肱静脉段的最适位置。     

Superficial venous patterns in the cubital region of Indians

The patterns of the superficial veins of the cubital region were studied in 536 Indian subjects both living and dead. Three basic pattern types were noted. Type I had a median cubital vein joining the cephalic and basilic veins in the cubital region. Type II had the cephalic vein itself draining into the basilic vein in the cubital region. Type III showed the absence of a direct communication between the cephalic and basilic veins in the cubital region. The median vein of the forearm in these latter cases joined either of the cephalic and the basilic veins (type III A) or after bifurcating into a median cephalic and a median basilic vein joined both these veins (type III B). Type I was found to be the most common pattern (67.5%) followed by type II (19.5%), with types III A and III B accounting for 6% and 6.5% of the cases, respectively. Renaming of the median cubital vein as the oblique cubital vein because of its direction and renaming of the median basilic and lateral basilic veins as medial and lateral cubital veins since they follow the medial and lateral borders of cubital fossa respectively has been suggested.     

Anatomy of arm veins: Significance for vein valve transplantation

Vein valve transplantation is a recently described operation to treat the sequelae of lower extremity venous hypertension resulting from valvular dysfunction. The operation involves harvesting a segment of an arm vein contianing a competent valve and transplanting it into a lower extremity vein. To determine the optimal incisions for obtaining a suitable valve-containing segment of vein, 20 cadaver arms were dissected. Cephalic, basilic, and brachial veins were examined for size, distribution of valves, and presence of tandem valves (defined as valves separated by 2 cm or less). Because patency rates are low in vascular grafts < 4 mm in diameter, only veins of this size or greater were considered adequate for transplantation. Cephalic veinswere found to have a consistently smaller diameter than basilic or brachial veins (P < 0.0001). Incisions for exposure of the basilic and brachial veins were evaluated. When exposure was limited to the middle third of the arm, an adequate vein, either the basilic or one of the brachial veins, was found in all cases. When either the distal or proximal third of the arm was exposed, however, an adequate vein was found in only 70% of the cases (P < 0.02). Tandem valves, although potentially useful, were present in only 5%, 25%, and 20%, respectively, of distal, middle, and proximal arm segments. Based on the results of this study, a medial incision along the middle third of the arm, exposing a basilic or brachial vein, is recommended as the optimal approach for vein harvesting in vein valve transplantation.     

The lateral thoracic artery passing through duplicated axillary vein: A case report

The axillary vein is a large‐blood vessel that lies on the medial side to the axillary artery. The veins of the axilla are more abundant than the arteries and their variations were extremely common. During educational dissection, a rare form of the axillary vein accompanying arterial variation was founded in left arm of 70‐year‐old female cadaver. The axillary vein was divided into two large veins, anterior and posterior axillary veins according to their anatomical position. The lateral‐thoracic artery arose from the second part of the axillary artery and passed through the gap of duplicated axillary vein. Before the lateral‐thoracic artery passed through the gap of duplicated axillary vein, the lateral‐thoracic artery gave‐off an additional branch, which descended superficial to the anterior axillary vein. It surrounded the anterior axillary vein as annular form and the diameter of surrounded part of the anterior axillary vein became narrow. This novel case was reported and its clinical implications of such a variant were discussed. Clin. Anat. 26:1014–1016, 2013. © 2012 Wiley Periodicals, Inc.     

Axillary vein perforation by the medial cutaneous nerve of the forearm

Variation in the venous pattern in the arm is common. In this study, a rare variant of the axillary vein and its association with the median cutaneous nerve of the forearm is described. In the axilla, the medial cutaneous nerve of the forearm penetrated the axillary vein, thereby creating two narrow venous channels at the site of passage. Such variations are important because a large number of diagnostic and therapeutic invasive procedures are carried out on veins. A possible mode of origin and the clinical importance of this variation are discussed.     

Anatomical variations of the iliolumbar vein with application to the anterior retroperitoneal approach to the lumbar spine: a cadaver study

Objectives of this study include identification of lumbosacral venous variations, designation of a critical area of dissection for surgical exposure, and comparison between both male/female and right/left-sided anatomy. Attempts were made to provide anatomic nomenclature that accurately describes these structures. Thirty-eight iliolumbar venous systems in 20 cadavers (11 females/9 males) were dissected. Each system was identified as one of three patterns of variation: common venous trunk (combining ascending lumbar and iliolumbar venous systems) with distal veins, common venous trunk without distal veins, and venous systems without a common venous trunk. Dimensions including distances to the inferior vena cava (IVC) confluence, the obturator nerve, and the lumbosacral trunk, and venous stem length were obtained to aid surgical dissection. Differences between males and females and those between right and left sides were compared. Anterior lumbosacral venous variations could be organized into three groups. A Type 1 venous system (common venous trunk with distal veins) was most common (53% of systems). The anatomical name "lateral lumbosacral veins" adequately describes the anatomical location of these veins and does not assume a direction of venous flow or the lack of individual distal veins. A critical area bordered by the obturator nerve anteriorly, the psoas muscle laterally, the spinal column medially, and sacrum posteriorly within 8.2 cm of the IVC confluence should be defined to adequately dissect the lateral lumbosacral veins. Differences in male and female lateral lumbosacral venous anatomy do not alter surgeon's approach to the anterior lumbar spine.     

Bilateral arterial and nervous variations in the human upper limb: A case report

During routine dissection, we found bilateral arterial and nervous anomalies in a female cadaver. On the left side the axillary artery divided into a medial brachial artery and lateral profunda brachii artery, and the musculocutaneous nerve arose from the upper trunk of the brachial plexus, before the formation of the lateral cord. On the right side a common trunk that divided into the circumflex scapular artery, thoracodorsal artery and posterior circumflex humeral artery was observed, while the musculocutaneous nerve fused with the median nerve.     

贵要静脉的应用解剖

目的为临床上行贵要静脉穿刺术,提高穿刺成功率提供贵要静脉的应用解剖学资料。方法选取经福尔马林浸泡的成人尸体标本33例共66侧。逐层解剖上肢,暴露贵要静脉。用游标卡尺来测量贵要静脉的长度和外径。并观察贵要静脉的起始情况,贵要静脉与相关神经及动脉之间的关系。结果贵要静脉长度,男性约335.01 mm,女性约331.50 mm;贵要静脉在前臂中部管径,男性约1.90 mm,女性约1.85 mm;贵要静脉接肘正中静脉处管径,男性约2.35 mm,女性约2.26 mm;贵要静脉末端管径,男性约2.90 mm,女性约2.60 mm。贵要静脉多数起于手背尺侧缘,少数起于第1手背静脉汇合处,后沿前臂尺侧上行,在肘窝下方转向前面,接收肘正中静脉后,经肱二头肌内侧沟上行至臂中部,穿深筋膜汇入肱静脉。贵要静脉深面是肱二头肌腱膜,此腱膜将贵要静脉与肱动脉、正中神经隔开,贵要静脉可跨过前臂内侧皮神经,前臂内侧皮神经亦可跨过贵要静脉。结论在肘部抽血时,如遇肘正中静脉缺如,以穿刺贵要静脉为宜;穿刺置管时如遇头静脉插管困难,以选择贵要静脉为宜。     

Rare variation of the axillary artery

The third part of the axillary artery unilaterally divides into two major arterial stems, named according to their localization as deep brachial artery and superficial brachial artery (brachial artery). The deep brachial artery gives off the posterior circumflex humeral artery, anterior circumflex humeral artery, subscapular artery, and profunda brachii artery. It continues its course in the arm lateral to the median nerve and terminates by giving a minute twig to the radial artery. The superficial brachial artery is larger in caliber than the deep brachial artery and gives no branches in the arm region. In the cubital fossa it gives the ulnar and the radial arteries. This case is a variant of the axillary artery that has been rarely (0.12-3.2%) documented in the literature. Accurate knowledge of the normal and variant arterial anatomy of the axillary artery is important for clinical procedures in this region. Clin. Anat. 13: 66-68, 2000.     

Anatomic considerations in placement of central venous catheters

A knowledge of anatomy is essential for efficient and skillful placement of central venous catheters in seriously ill patients. The anatomy of the femoral, brachial, axillary, subclavian, external jugular, and internal jugular veins is described, and landmarks useful in achieving successful cannulation are discussed. Infectious and thrombotic complications of long-term cannulation are reviewed. Catheterization of the umbilical vein in the newborn infant is a very useful alternative approach to central venous cannulation in this age group.     

Number and location of venous valves within the popliteal and femoral veins: a review of the literature

Although deep venous insufficiency is common and important, the anatomy of deep vein valves is poorly understood. The aim of this study was to investigate the location, number and consistency of venous valves in the femoral and popliteal veins in normal subjects. A detailed literature search of PubMed was performed. Abstracts and selected full text articles were scrutinised and relevant studies published between 1949 and 2010 reporting anatomical details of deep vein valves were included. From 7470 articles identified by the initial search strategy, nine studies with a total of 476 legs were included in this review. All studies were cadaveric and subjects ranged from stillborn fetuses to 103 years of age. Studies suggested that femoral veins contain between one and six valves, and popliteal veins contain between zero and four valves. Deep vein valves were consistently located in the common femoral vein (within 5 cm of the inguinal ligament), the femoral vein (within 3 cm of the deep femoral vein tributary) and in the popliteal vein near the adductor hiatus. Valves are consistently located at specific locations in the deep veins of the leg, although there is often significant variability between subjects. Further anatomical and functional studies using new imaging modalities available should target these areas to identify whether certain valves play a more important role in venous disease. This may guide us in the development of new treatment options for patients with deep venous disease.     

Surface marking of axillary vein

IntroductionPrecise identification of axillary vein during axillary lymph node dissection is an important step. Trainees in surgery often find it difficult to identify the exact level of axillary vein because surface marking of axillary vein is not described in most standard textbooks of anatomy and operative surgery.MethodsWe have identified the surface markings for axillary vein on 150 patients undergoing axillary lymph node dissection. We mark the axillary crease of skin between upper arm and axilla and identify two distinct dimples at the anterior and posterior ends of this skin crease. We then place a finger horizontally at the midpoint between the two dimples directed towards lateral edge of pectoralis major muscle. This position of finger marks the surface anatomy of underlying axillary vein.ResultsThe axillary vein was found to be located deep to this surface marking. In some patients, the marking was found to overlap the width of axillary vein partially. However, in all cases atleast some part of vein lies deep to the midpoint of two axillary crease dimples.DiscussionA simple and a reliable technique of locating the axillary vein using surface landmarks is described.     

Life without the vein of Galen: Clinical and radiographic sequelae

A thorough understanding of the anatomy of the pineal region, particularly venous drainage, is critical for gaining open surgical access to the pineal gland. The adverse sequelae after intraoperative venous occlusion are assumed to be catastrophic but have been scarcely reported. We report a case of pineocytoma in which the vein of Galen was ligated without postoperative adverse sequelae. Pineal region anatomy with emphasis on deep veins was reviewed in large anatomical studies. There are tremendous anatomical variations in the vein of Galen and its tributaries. Several confounding factors can be encountered during surgery and may lead to accidental sacrifice of the vein of Galen. Survival after focal occlusion of a major deep vein depends on the development of collateral circulation as shown in our case report. Venous drainage remains the cornerstone in the surgical planning of the pineal region. Anatomical variations and venous collaterals undoubtedly contributed to the mixed reports of adverse sequelae after venous sacrifice. Vein of Galen ligation may be survivable but consequences cannot be predicted without a thorough pre-ligation assessment of regional venous collateral drainage. Thorough understanding of the venous anatomy, meticulous planning of the surgical approach and avoidance of the occlusion of the vein of Galen and its major tributaries are key factors to successful pineal region surgery.     

Topographical anatomy of superficial veins, cutaneous nerves, and arteries at venipuncture sites in the cubital fossa

We investigated correlations among the superficial veins, cutaneous nerves, arteries, and venous valves in 128 cadaveric arms in order to choose safe venipuncture sites in the cubital fossa. The running patterns of the superficial veins were classified into four types (I–IV) and two subtypes (a and b). In types I and II, the median cubital vein (MCV) was connected obliquely between the cephalic and basilic veins in an N-shape, while the median antebrachial vein (MAV) opened into the MCV in type I and into the basilic vein in type II. In type III, the MCV did not exist. In type IV, additional superficial veins above the cephalic and basilic veins were developed around the cubital fossa. In types Ib–IVb, the accessory cephalic vein was developed under the same conditions as seen in types Ia–IVa, respectively. The lateral cutaneous nerve of the forearm descended deeply along the cephalic vein in 124 cases (97 %), while the medial cutaneous nerve of the forearm descended superficially along the basilic vein in 94 (73 %). A superficial brachial artery was found in 27 cases (21 %) and passed deeply under the ulnar side of the MCV. A median superficial antebrachial artery was found in 1 case (1 %), which passed deeply under the ulnar side of the MCV and ran along the MAV. Venous valves were found at 239 points in 28 cases with superficial veins, with a single valve seen at 79 points (33 %) and double valves at 160 points (67 %). At the time of intravenous injection, caution is needed regarding the locations of cutaneous nerves, brachial and superficial brachial arteries, and venous valves. The area ranging from the middle segment of the MCV to the confluence between the MCV and cephalic vein appears to be a relatively safe venipuncture site.     

Anatomical and radiological evidence for the iliolumbar vein as an inferior lumbar venous system

The purpose of this work was to study an inferior lumbar venous system, which turned out to be the vertical component of the iliolumbar vein as defined in early works by Bourgery and Jacob, though there is a terminological ambiguity between the iliolumbar vein and the ascending lumbar vein in the literature. However, the iliolumbar vein is most commonly defined as a vein draining the fourth and fifth lumbar vertebral segments. Cadaver studies, including one injection-corrosion, and in vivo venograms were analyzed by visual inspection and measurements. Whether the injection was made via the axillary or the saphenous veins, the inferior lumbar vein was always filled, demonstrating that it is part of the vertebral venous system. An interruption or a plexiform shape of the venous system at the level of the third lumbar vertebra, and an increase in caliber as this vein runs downwards, allowed differentiating the inferior lumbar vein from the ascending lumbar vein. The inferior lumbar vein and the superior iliac vein drained into the iliac veins, either external or internal iliac vein, but typically into the common iliac vein, separately or with a single common trunk. This common trunk was observed in 92% of the dissected cases on the right side and in 46% on the left, whereas it was seen in 50% of the radiological studies on the right side and 52% on the left. Consequently, the inferior lumbar vein was the main component of the iliolumbar vein, and as such should be differentiated from the ascending lumbar vein.     

经贵要静脉行PICC置管的解剖观察

目的为临床上行贵要静脉穿刺术,提高穿刺成功率提供贵要静脉的应用解剖学资料。方法:选取经福尔马林浸泡的成人尸体标本33例共66侧。逐层解剖上肢,暴露贵要静脉。用游标卡尺来测量贵要静脉的长度和外径。并观察贵要静脉的起始情况,贵要静脉与相关神经及动脉之间的关系。结果贵要静脉长度,男性约335.01mm,女性约331.50mm;贵要静脉在前臂中部管径,男性约1.90mm,女性约1.85mm;贵要静脉接肘正中静脉处管径,男性约2.35mm,女性约2.26mm;贵要静脉末端管径,男性约2.90mm,女性约2.60mm。贵要静脉多数起于手背尺侧缘,少数起于第1手背静脉汇合处,后沿前臂尺侧上行,在肘窝下方转向前面,接收肘正中静脉后,经肱二头肌内侧沟上行至臂中部,穿深筋膜汇入肱静脉。贵要静脉深面是肱二头肌腱膜,此腱膜将贵要静脉与肱动脉、正中神经隔开,贵要静脉可跨过前臂内侧皮神经,前臂内侧皮神经亦可跨过贵要静脉。结论在肘部抽血时,如遇肘正中静脉缺如,以穿刺贵要静脉为宜;穿刺置管时如遇头静脉插管困难,以选择贵要静脉为宜。     

Breathing Life into the Cadaver: Introducing Air Dissection As a New Teaching and Dissecting Method for the Venous System

Air insufflation has been used for various surgical procedures such as during laparoscopy. We hypothesized that the use of pressurized air might enable cadaveric dissection to differentiate smaller veins better than traditional dissection techniques. In three fresh‐frozen cadavers, the inferior vena cava (IVC) and right or left femoral veins were exposed just distal to the inguinal ligament and a needle placed into one of them. Pressurized air was then placed into the cannulated femoral vein using an air compressor. In all specimens, the IVC and most of its tributaries, both left and right sides, were clearly insufflated. When the IVC was traced superiorly by resecting the diaphragm through the caval foramen, the right atrium and ventricle were also found to be dilated. Additionally, venous variants that would have not been obvious without dilatation of the IVC were identified. Air dissection of the venous system in fresh‐frozen cadavers aids in anatomical dissection. Such a model might also serve as a surgical training model and teaching tool as it better mimics life‐like anatomy and physiology. We term this technique “cadaveric air dissection.” Clin. Anat. 32:566–572, 2019. © 2019 Wiley Periodicals, Inc.