6. Venous structure

**Venous Drainage of the Upper Limb**

Separated into superficial and deep systems. Both systems contains valves with anastomosis between the two.

**Superficial System**

Dorsal Digital Veins drain into three dorsal Metacarpal Veins which unite to form a dorsal venous network superficial to the metacarpals called the dorsal venous arch. The cephalic vein comes from the radial side, and the basilic vein comes from the ulnar side of the arch

Cephalic Vein

* Winds superiorly from the radial side of the hand to the anterior surface of the forearm.
* Drains the lateral forearm and communicates with the basilic vein via the median cubital vein at the antecubital fossa
* Crosses the elbow superficial to the lateral cutaneous nerve of the forearm
* Ascends in the arm lateral to the biceps muscle then obliquely over the deltoid
* Passes between the deltoid and pectoralis major and through the deltopectoral triangle to terminate in the axillary vein

BasilicVein

* Mirrors the cephalic vein on the ulnar side of the forearm
* Ascends over the postero-ulnar aspect of the forearm and become anterior just below the elbow
* Joined by the median cubital vein.
* Ascends in the arm superficial to the groove between biceps and triceps. The median nerve, brachial artery and medial antebrachial cutaneous nerve lies deep to it.
* It pierces the deep fascia near the junction of the middle and inferior thirds of the arm runs deep to the brachial artery into the axilla and join the brachial vein to become the axillary vein at the lower border of the teres major

Median Cubital Vein

* Communication between the basilic and cephalic veins in the cubital fossa
* Lies anterior to the bicipital aponeurosis
* Drains the superficial palmar venous network and the volar surface of the forearm

Median Ante-brachial Vein

* Runs up the middle of the volar surface of the forearm
* Terminates in the basilic or median cubital vein

**Deep System :** deep vein is usually small as most of the upper limb is drained by the superficial system

Superficial and deep palmar arches are accompanied by the venae commitantes, known as the superficial and deep venous arches.

Radial and Ulna Veins

* Veins accompany the radial and ulna arteries
* Near the elbow the ulnar vein receives tributaries from the ant. and post interosseus companion veins
* Sends a branch to the median cubital vein

Brachial Veins

* Runs with the brachial artery
* Anastomose freely with each other and the superficial system

Axillary Vein

* Continuation of the basilic vein above the teres major muscle
* Receives the brachial veins then the subscapular and cephalic veins near its termination
* Other tributaries correspond to tributaries of the arteries
* Becomes the subclavian vein at the lower border of the first rib
* Between the vein and artery run the medial pectoral nerve, ulnar nerve and the medial cutaneous nerve of the forearm
* Intimately related to the internal axillary lymph nodes

Subclavian Vein

* Runs from the lower border of the first rib in a shallow groove to the medialborder of scalenus anterior
* Becomes the brachiocephalic vein on uniting with the IJV
* The only tributaries is EJV
* Separated from the subclavian artery by scalenus anterior and the phrenic nerve