Variations of the iliac and pelvic venous systems with special attention to the drainage patterns of the ascending lumbar and iliolumbar veins

The anatomy of the inferior vena cava (IVC) and common, external and internal iliac veins (CIV, EIV, IIV respectively) was examined in 59 embalmed adult human cadavers of Caucasian origin. In the present study, we focus our attention on the drainage patterns of the ascending lumbar and iliolumbar veins (ALV, ILV) when there are variations in the major pelvic veins by highlighting and describing the variations themselves. The above patterns, when no variations exist, have already been reported. Among the 59 cadavers, nine (9/59, 15.3%) presented anomalies of the major pelvic veins, as follows: anomalous drainage of both EIV and IIV in 8.5% of the specimens (5/59, Type I); variations of the IVC in 3.4% (2/59, Type II); duplication of the IIV (1/59=1.7%, Type III); anastomotic branch between the right IIV and the left CIV (1/59=1.7%, Type IV). ALV drained either into the CIV (8/18 sides, 44.4%) or in EIV (5/18 sides, 27.8%), while absence of ILV was the most frequent pattern (8/18 sides, 44.4%). A common trunk, joining the two veins, was observed in 5/18 sides (27.8%). Those drainage patterns were in accordance with the ones discovered in our previous study. In Type I the two veins always drained into the EIV. Knowledge of the surgical anatomy of all studied veins may prevent injury to these veins during operations in the retroperitoneal space and pelvis or malposition of venous catheters placed from the groin.     

下腰椎侧前方静脉的解剖及其在腹腔镜腰椎手术中的临床意义

目的：探索在腹膜后腹腔镜行下腰椎手术时，下腰椎侧前方血管的解剖及手术暴露时的注意事项。方法：对15具腰椎标本两侧观察腰升静脉和髂腰静脉走行、变异及其与周围组织的关系。结果：腰升静脉和髂腰静脉在每具标本中均存在，有静脉分干和共干汇流到髂总静脉等4种形式。在牵拉髂总静脉时，可能导致它们的破裂，并且在暴露血管时需注意避免损伤闭孔神经和腰骶干。结论：髂腰静脉和腰升静脉是下腰椎很重要的解剖结构，腹腔镜手术显露下腰椎时应注意在牵拉髂总静脉时暴露和结扎这两个静脉，是手术避免血管破裂导致大出血的关键。     

Avulsion of ascending lumbar and iliolumbar veins in anterior spinal surgery: an anatomical study

To expose the disc between the 4th and 5th lumbar vertebrae in anterior spinal surgery, left to right retraction of inferior vena cava and aorta is required. This manoeuvre can be complicated by venous haemorrhage that, in most cases, is due to avulsion of the left ascending lumbar vein (ALV) or the left iliolumbar vein (ILV). We dissected 23 embalmed cadavers to assess the factors that contribute to the risk of tearing these two veins during retraction. We describe a triangular region that should help surgeons in identifying the ALV and ILV. This triangle is defined by the lateral border of the common iliac vein, the medial border of the psoas major muscle, and the superior end-plate of the L5 vertebral body. We observed that 3 cm between the termination of the left ALV, or a common stem with the ILV, and the termination of the common iliac vein is the critical distance, less than which the risk of venous avulsion is highest. Although the sample considered is small, our study seems to suggest that male patients tend to have a higher risk of venous avulsion than female patients.     

Novel findings of the anatomy and variations of the axillary vein and its tributaries

The anatomy and variations of the axillary vein has significant implications in various invasive procedures such as venous access, axillary block, arteriovenous fistula creation, axillary node dissection, breast augmentation, and other surgical procedures involving the axilla. To clarify the anatomy of the axillary vein and its tributaries, 40 cadaveric upper extremities were examined after dissection and were classified into several types according to the courses and terminations of brachial veins. The brachial veins ended separately (Type A; 72.5%) or made a common brachial vein (Type B; 27.5%) to enter the basilic vein or the axillary vein. The basilic vein was absent in 5.0% of the specimens. Duplication of the axillary vein was observed in 17.5% of the specimens and the lateral venous channel running along the lateral wall of the axilla was observed in 40.0% of the specimens. The most common drainage vein of the deep brachial vein was the lateral brachial vein (67.5%). The anterior circumflex humeral vein also emptied into the lateral brachial vein in 67.5% of the specimens. The posterior circumflex humeral vein crossed posterior side of the brachial plexus to join either the axillary vein (45.0%) or subscapular vein (42.5%). Perforation of the lateral root of median nerve by a lateral brachial vein, a common brachial vein, or a venous channel was observed in 15.0% of the specimens. Other venous variations accompanying the variations of the axillary artery or the brachial artery are described herein. The clinical importance of these findings is described in the discussion. Clin. Anat. 25:893–902, 2012. © 2012 Wiley Periodicals, Inc.     

Variation in Number and Drainage Pattern of Pulmonary Veins Draining into the Left Atrium

Pulmonary veins carry oxygenated blood from the lungs to the left atrium of the heart. The variation in the number and drainage pattern of pulmonary veins is frequent and this knowledge is valuable for various procedures involving the pulmonary veins. The present study is done on 29 hearts obtained from formalin fixed cadavers from the dissecting room of department of anatomy, MAMC, Agroha, Hisar. The left atrium of these hearts was studied from external aspect for the number of pulmonary veins draining into left atrium and from internal aspect for the drainage pattern. In 13 out of 29 hearts (44.8%), variation in number of pulmonary vein was observed. In the present study the most common variation of right pulmonary veins is three veins with two ostia (10.3%) and the most common variation of left pulmonary veins is a single vein with a single ostium (17.2%).The variations of pulmonary veins are quite common with an equivocal variability in right-sided and left-sided drainage patterns. A classification is proposed to describe these variations to facilitate communication with referring clinicians.     

Facial vein draining into external jugular vein in humans: its variations,phylogenetic retention and clinical relevance

The superficial veins, especially the external jugular vein (EJV), are increasingly being utilized for cannulation to conduct diagnostic procedures or intravenous therapies. Ultrasound-guided venipuncture is a viable possibility in cases of variations in the patterns of superficial veins, and their knowledge is also important for surgeons doing reconstructive surgery. This study was done on 89 dissected adult cadavers (178 sides) and variations in patterns of termination of the facial vein (FV) into the EJV were studied. The FV in 16 sides (9%) was found to drain into the EJV, in two main patterns: type I and type II. Type I had the FV draining into the EJV with varying degrees of obliquity in a Y-shaped (6 cases, 37.5%), U-shaped (3 cases, 18.7%), tuning-fork-shaped (2 cases, 12.5%) or N-shaped (1 case, 6.2%) pattern. Type II showed an inverted A-shaped pattern (2 cases, 12.5%) or a stepladder-shaped pattern (2 cases, 12.5%) depending on the presence of one or more connecting conduits between the FV and EJV respectively. In Macaca mulatta(rhesus monkey) a pair of vertically disposed, subcutaneous veins placed nearly side by side and of equal caliber were seen on each side of the neck. The lateral vein was the EJV while the medial one took the course of the FV in the upper oblique segment and ran parallel to the EJV in the lower segment over the sternocleidomastoid, with one or two transverse communications. The anomalous patterns found in our study could be explained in terms of the regression and retention of various parts of the veins found in the rhesus monkey, or the drainage pattern found in horse, ox and dog, where the vein from the face drain into the external jugular vein, the internal jugular vein being either absent or a small vessel accompanying the carotid artery.     

Termination of the vertebral veins: Evaluation by multidetector row computed tomography

The purpose of this study was to evaluate the topographic anatomy of the vertebral vein (VV) in the lower neck and thoracic inlet using CT scans. Enhanced CT scans using 32‐MDCT were obtained for 199 consecutive patients. Reconstructed images with 1‐mm section thickness/intervals were evaluated by two radiologists examining the drainage point, number, and route of VVs using frame forwarding and the rewind function on the DICOM viewer. The VV was classified into four types as follows: Type A (80.6%), a VV that descended ventral to the subclavian artery (SA) and drained into the upper portion of the brachiocephalic vein (BCV); Type B (5.8%), a VV that descended dorsal to the SA and drained into the upper portion or the lower portion of the BCV; Type C (8.3%), a doubled VVs that crossed both sides of the SA and drained into the upper portion of the BCV and formed a common trunk; Type D (5.3%), a VV ventral to the SA that drained into the upper portion of the BCV and another VV dorsal to the SA drained into the upper portion or the lower portion of the BCV. Some variations were observed in regard to the drainage point, number, and route of the VVs. Classification of the VV may be useful for interpreting chest CT scans and in better understanding the embryologic development of the vertebral vein. Clin. Anat. 23:662–672, 2010. © 2010 Wiley‐Liss, Inc.     

右下肺静脉及其属支分布与汇合模式分型的多层螺旋CT影像解剖学研究

目的 探讨右下肺静脉(RLL)属支的多层螺旋CT血管造影(MSCTA)影像解剖学分布特征、汇合模式分型及其临床应用价值。方法 采用回顾性横断面研究方法。自2017年3月—2018年7月泰山医学院附属医院行MSCTA检查的病例中,筛选肺静脉及属支显示优良者100例,其中男54例、女46例,年龄24～86(58.9±13.54)岁。将MSCTA原始图像传到后处理工作站,进行容积再现(VR)和多平面重组(MPR),观察右下肺静脉属支数目、分布特征及汇合方式,进而对其进行命名和分型。结果 右下肺静脉整体汇合方式分型有RLLⅠ型(2支型)、RLLⅡ型(3支型)、RLLⅢ型(4支型),分别占67%(67/100)、28%(28/100)、5%(5/100)。RLLⅠ型最常见,有2种汇合方式、5种分型;RLLⅡ型最复杂,有6种汇合方式、7种分型;RLLⅢ型最少见,有4种汇合方式、4种分型。少见的静脉引流模式中,异位中叶静脉(异位V4、异位V4+V5)和异位上叶静脉(异位V2)分别占7%(7/100)和4%(4/100)。上段静脉分为单干型和双干型,分别占88%(88/100)、12%(12/100)。内侧底段静脉(V7)为最细小的底段静脉,其汇入处无规律,共统计了10种汇入情况。前段静脉(V8)、外侧底段静脉(V9)、后底段静脉(V110)有二分支型、三分支型和四分支型3种型式,分别占95%(95/100)、4%(4/100)和1%(1/100)。结论 右下肺静脉属支引流及汇合模式复杂多变;手术前MSCTA可清晰显示肺静脉属支的分布规律,从而提高胸腔镜下解剖性肺段切除术的安全性。     

下肢股段主要静脉及其瓣膜的解剖及临床意义

目的通过对103侧成人尸体下肢股段主要静脉及其瓣膜的观测,为临床血管疾病的外科及介入诊疗提供形态学依据。方法在103侧成人尸体下肢股段中观测主要静脉瓣膜的数量及形状、静脉特别点外径、静脉特别点的体表位置。结果大隐静脉股段瓣膜均为双瓣型,隐股点处外径(真径)为(5.18±1.25)mm,隐股点至腹股沟韧带的距离为(3.92±0.71)cm;股浅静脉第一对瓣膜多为双瓣型,瓣膜附着缘静脉外径(压扁径)为(1.06±0.17)cm,其位置较恒定,距股深静脉入口下缘(1.16±0.66)cm,到隐股点距离为(6.16±1.69)cm;股深静脉注入点下缘至隐股点下缘的距离为(5.00±1.57)cm,至腹股沟韧带的距离为(7.84±1.89)cm。结论以上观测结果为临床血管外科手术及介入治疗提供解剖学基础。     

Anatomical variations of the internal iliac veins in the presacral area: Clinical implications during sacral colpopepxy or extended pelvic lymphadenectomy

The purpose of this study was to classify anatomical variations of the internal iliac vein (IIV) in relation to robotic or laparoscopic extended lymphadenectomy. Between March 2011 and July 2012, 60 consecutive patients underwent robotic or laparoscopic extended lymphadenectomy. We retrospectively reviewed surgical video clips and analyzed the pattern of the IIVs in the presacral area. IIV variations were classified into seven types: Type A, normal (n = 39, 65.0%); Type A with a dilated middle sacral vein (n = 5, 8.3%); Type B, left IIV connecting centrally to the left external iliac vein (n = 5, 8.3%); Type C, a separated trunk of the left IIV draining into the left central common iliac vein (CIV; n = 1, 1.7%); Type D, a separated trunk of the right IIV draining into the left central CIV (n = 8, 13.3%); Type E, a separated trunk of the right IIV draining into the right central CIV (n = 0, 0%); and Type F, separated trunks of the bilateral IIV connecting with each other before draining into the left central CIV (n = 2, 3.3%). The prevalence of IIV anomalies was 26.7%; the incidence of separated IIV trunks was 18.3%. To prevent life‐threatening IIV injury during extended lymphadenectomy or sacral colpopexy, the anatomical variations of the IIVs should be known exactly. Clin. Anat. 28:661–664, 2015. © 2014 Wiley Periodicals, Inc.     

睾丸静脉曲张手术治疗的应用解剖学

从临床应用的角度,对３０ 具（６０ 侧）成年男性尸体的睾丸静脉、腹壁下静脉（内侧支）、旋髂深静脉进行解剖观测。提出睾丸静脉与腹壁下静脉吻合术为治疗睾丸静脉曲张转流术的首选术式。其次,也可配合睾丸静脉与旋髂深静脉吻合术,治疗较严重的睾丸静脉曲张     

Anatomical variations of pulmonary venous drainage in Thai people: multidetector CT study

Objective:

To evaluate the patterns of pulmonary venous drainage into the left atrium and to determine the frequency of each variant of pulmonary venous anatomy.

Materials and methods:

After institutional review board approval (No. 09JUL011148), 300 studies of thoracic multidetector computed tomography were retrospectively reviewed for the anatomical features of the pulmonary vein and its drainage pattern into the left atrium. The percentage of each pattern was calculated.

Results:

The anatomy of pulmonary venous drainage in 300 patients (150 male and 150 female, mean age 60.16 years) showed some variation. In the right pulmonary vein, the most common drainage pattern was two ostia (90.33%), followed by three to five ostia (6.33%) and a single ostium (3.33%). There were one or two separate middle lobe vein ostia in groups of more than two openings. On the left side, there were two patterns; a single venous ostium (59%) was much more common than two ostia (41%). In both right and left pulmonary veins, there were five cases (2 male, 3 female) that had a single pulmonary venous ostium, bilaterally. However, there were only 17 cases (5.67%), out of 300 enrolled in this study, that had bilateral pulmonary venous ostial variations.

Conclusion:

A classification system to succinctly describe pulmonary venous drainage patterns was developed. In left-sided drainage, a single left pulmonary ostium was the most common variation. The right-sided venous drainage varied more in both number and pattern than those of the left side; nevertheless, bilateral pulmonary venous ostial variation was not frequently found.     

颞叶桥静脉的显微解剖及临床意义

目的：系统了解颞叶桥静脉及其属支的显微解剖。方法：在手术显微镜下观察10例20侧成人头部标本的颞叶桥静脉，由各属支起源追踪至静脉汇入点，测量有关数据。结果：颞叶桥静脉有4型：Ⅰ静脉湖型15％(3侧)，Ⅱ烛台型40％(8侧)，Ⅲ单干型20％(4侧)，Ⅳ多干型25％(5侧)。20侧半球共有107条桥静脉属支、43个静脉汇入点，静脉汇入点分布于横窦区54％(23个)、小脑幕区23％(10个)、颞骨岩部区23％(10个)。结论：熟悉颞叶桥静脉的显微解剖，是在相关手术中保护桥静脉的基础。     

国人中脑静脉的显微解剖

本文报道采用动-静脉连续灌注法,区别动、静脉。经厚切片透明,在SXP-1手术显微镜下观察了27例(54侧)成人中脑浅层的脚间静脉、后交通静脉、大脑脚外侧静脉、旋大脑脚静脉、脑桥中脑沟静脉、中脑外侧静脉、结合臂静脉、小脑前中央静脉和四叠体静脉的形态、出现率、收集属支及汇流情况。还观察了10个中脑内部静脉的中脑前内侧、前外侧、外侧和后静脉的起始、行程、穿出点和汇流情况。同时作了3个中脑静脉造影作为对照,并结合临床进行了讨论。     

Congenital anomalies of left renal vein and its clinical importance: A case report and review of literature

Detailed knowledge of the anatomy and anomalies of renal veins is necessary for retroperitoneal surgery and venographic procedures. According to Thomas (1970, Arch. Surg. 100:738–740), the anomalies of renal veins are more frequent than estimated. The number of surgical procedures and radiologic examinations related to the retroperitoneum are increasing, and therefore pathologic conditions of the retroperitoneal area have been discussed more frequently. We report on a retroaortic left renal vein joining the left common iliac vein, discuss the embryology and clinical importance of renal vein anomalies, and give an overview on the relevant literature. © 1996 Wiley-Liss, Inc.     

Proposal for a new classification of variations in the iliac venous system based on internal iliac veins: a case series and a review of double and left inferior vena cava

There are many reports on variations in the inferior vena cava (IVC), particularly double IVC (DIVC) and left IVC (LIVC). However, no systematic report has recorded iliac vein (IV) flow patterns in the DIVC and LIVC. In this study, we examined IV flow patterns in both DIVC and LIVC observed during gross anatomy courses conducted for medical students and in previously reported cases. During the gross anatomy courses, three cases of DIVC and one case of LIVC were found in 618 cadavers. The IV flow pattern from these four cases and all other previously reported cases can be classified into one of the following three types according to the vein into which the internal iliac vein drained: the ipsilateral external IV; confluence of the ipsilateral external IV and IVC; and the communicating vein, which connects the IVC and the contralateral IVC or its iliac branch. This classification, which is based on the internal IV course, is considered to be useful because IV variations have the potential to cause clinical problems during related retroperitoneal surgery, venous interventional radiology, and diagnostic procedures for pelvic cancer.     

Variability of the obturator vessels

The obturator artery and vein are usually described as branches or tributaries of the internal iliac vessels although variations with connections to the external iliac or inferior epigastric vessels have been reported. Because these anomalous vessels are at risk in groin or pelvic surgeries that require dissection or suturing along the pelvic rim, we measured the frequency of these variations in 105 pelvic walls (45 in the United States and 60 in China). Our data show that 70–82% of pelvic halves and 83–90% of whole pelves had an artery, vein, or both in the variant position. Arteries were most often found in the normal position only but normal and anomalous veins were most frequently found together. These data show that it is far more common to find a vessel coursing over the pelvic rim at this site than not and have implications for both pelvic surgeons and anatomists. Clin. Anat. 10:328–332, 1997. © 1997 Wiley-Liss, Inc.     

An anatomical classification of the variations of the inferior phrenic vein

The majority of anatomical textbooks of gross anatomy offer very little information concerning the anatomy and distribution of the inferior phrenic vein (IPV). However, in the last decade, an increasing number of reports have arisen, with reference to the endoscopic embolization of esophageal and paraesophageal varices, as well as venous drainage of hepatocellular carcinomas (HCC). The IPV is one of the major sources of collateral venous drainage in portal hypertension and HCC. The aim of this study was to identify the origin and distribution of the IPVs (right and left), both in normal and (selective) pathological cases. We have examined 300 formalin-fixed adult cadavers, without any visible gastrointestinal disease, and 30 cadavers derived from patients with HCC. The right IPV drained into the following: the inferior vena cava (IVC) inferior to the diaphragm in 90%, the right hepatic vein in 8%, and the IVC superior to the diaphragm in 2%. The left IPV drained into the following: the IVC inferior to the diaphragm in 37%, the left suprarenal vein in 25%, the left renal vein in 15%, the left hepatic vein in 14%, and both the IVC and the left adrenal vein in 1% of the specimens. The IPVs possessed four notable tributaries: anterior, esophageal, lateral and medial. The right IPV served as one of the major extrahepatic draining veins for all 30 cases of HCC. These findings could have potential clinical implications in the transcatheter embolization of esophageal and paraesophageal varices, as well as in mobilizing the supradiaphragmatic segment of IVC.     

腘静脉的组成及其瓣膜的观测

对100侧成人尸体各23侧童尸下肢小腿深静脉的观察和测量,结果表明:腘静脉的支数以2支型最多(65.85%);腘静脉的组成分2个主型和10个亚型,以Ⅰ a 型最多(26.39%);腘静脉外径(成人86侧)1支型平均值为6.03mm、2支型大支为6.35mm,小腿诸深静脉外径均较细小。102侧腘静脉中平均每条腘静脉有2.26个瓣,一条腘静脉内有2个瓣者最多(53.92%);腘静脉第1段第1瓣位置平均在膝关节线以上12.06cm,胭静脉第2段第1瓣位置在膝关节线以下2.08cm。92侧小隐静脉的回流分3型,正常型最多见(占78.26%)。     

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.