Thoracoepigastric vein

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Thoracoepigastric vein
Details
Drains to Lateral thoracic vein, femoral vein
Identifiers
Latin Vena thoracoepigastrica
Anatomical terminology

The thoracoepigastric vein runs along the lateral aspect of the trunk between the superficial epigastric vein below and the lateral thoracic vein above and establishes an important communication between the femoral vein and axillary vein. This is an especially important vein when the inferior vena cava (IVC) becomes obstructed, by providing a means of collateral venous return. It creates a cavocaval anastomosis by connecting with superficial epigastric veins arising from femoral vein just below inguinal ligament.

Superficial epigastric vein Large blood vessel

The superficial epigastric vein is a vein which travels with the superficial epigastric artery. It joins the accessory saphenous vein near the fossa ovalis.

Lateral thoracic vein Large blood vessel

The lateral thoracic vein is a tributary of the axillary vein. It runs with the lateral thoracic artery and drains the Serratus anterior muscle and the Pectoralis major muscle.

Femoral vein Large blood vessel in the leg

In the human body, the femoral vein is a blood vessel that accompanies the femoral artery in the femoral sheath. It begins at the adductor hiatus and is a continuation of the popliteal vein. It ends at the inferior margin of the inguinal ligament, where it becomes the external iliac vein. The femoral vein bears valves which are mostly bicuspid and whose number is variable between individuals and often between left and right leg.

Clinical significance

The thoracoepigastric vein is unique in that it drains to both the Superior Vena Cava (SVC) and to the Inferior Vena Cava (IVC). Hence, it serves as an anastomotic caval-caval link between the two. Furthermore, the thoracoepigastric vein is connected to the portal vein via the paraumbilical vein and thereby serves as a portocaval anastomosis as well. When a patient experiences portal hypertension, there can be congestion (backup) of blood that enters into the caval system via the thoracoepigastric vein. When this occurs, there can be an externally visible dilation of the paraumbilical (and perhaps even the thoracoepigastric veins) which leads to the appearance of "Caput Medusae". Caput Medusae is a clinical sign that is recognized by the physician by the characteristic appearance of distended veins emanating from the umbilicus of the patient. The shape of these veins and their arrangement around the umbilicus is said to resemble the snake-like hair of the mythological Greek Monster, Medusa. "Caput Medusae" [Latin] means "Head of Medusa".

Superior vena cava One of two veinous trunks bringing deoxygenated blood back to the heart

The superior vena cava (SVC) is the superior of the two venae cavae, the great venous trunks that return deoxygenated blood from the systemic circulation to the right atrium of the heart. It is a large-diameter (24 mm), yet short, vein that receives venous return from the upper half of the body, above the diaphragm. The SVC is located in the anterior right superior mediastinum. It is the typical site of central venous access (CVA) via a central venous catheter or a peripherally inserted central catheter. Mentions of "the cava" without further specification usually refer to the SVC.

Portal vein

The portal vein or hepatic portal vein is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approximately 75% of total liver blood flow is through the portal vein, with the remainder coming from the hepatic artery proper. The blood leaves the liver to the heart in the hepatic veins.

In the course of the round ligament of liver, small veins (paraumbilical) are found which establish an anastomosis between the veins of the anterior abdominal wall and the hepatic portal, hypogastric, and iliac veins.

Related Research Articles

Femoral artery Large artery in the thigh

The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. It enters the thigh from behind the inguinal ligament as the continuation of the external iliac artery. Injuries to the femoral artery can require reattachment surgery.

Inferior vena cava One of two veinous trunks bringing deoxygenated blood back to the heart

The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. Its walls are rigid and it has valves so the blood does not flow down via gravity. It is formed by the joining of the right and the left common iliac veins, usually at the level of the fifth lumbar vertebra.

Azygos vein

The azygos vein is a vein running up the side of the thoracic vertebral column draining itself towards the superior vena cava. It connects the systems of superior vena cava and inferior vena cava and can provide an alternative path for blood to the right atrium when either of the venae cavae is blocked.

Abdominal aorta

The abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of the descending aorta.

Caput medusae appearance of distended and engorged superficial epigastric veins

Caput medusae is the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen. The name caput medusae originates from the apparent similarity to Medusa's head, which had venomous snakes in place of hair. It is also a sign of portal hypertension. It is caused by dilation of the paraumbilical veins, which carry oxygenated blood from mother to fetus in utero and normally close within one week of birth, becoming re-canalised due to portal hypertension caused by liver failure.

Inguinal lymph nodes

Inguinal lymph nodes are the lymph nodes in the inguinal region (groin). They are located in the femoral triangle, and are grouped into superficial lymph nodes, and deep lymph nodes. The superficial lymph nodes have three divisions – the superomedial, superolateral, and inferior superficial lymph nodes.

Renal vein

The renal veins are veins that drain the kidney. They connect the kidney to the inferior vena cava. They carry the blood filtered by the kidney.

Inferior vena cava filter type of vascular filter

An inferior vena cava filter is a type of vascular filter, a medical device that is implanted by interventional radiologists or vascular surgeons into the inferior vena cava to presumably prevent life-threatening pulmonary emboli (PEs). Their effectiveness and safety profile is not well established, and in general, they are only recommended in some high-risk scenarios. They are not intended to be a replacement for medical (drug-based) management of venous thromboembolism (VTE). However, in cases where patients are at high risk of developing a clinically significant PE and cannot be sufficiently anticoagulated, placement of an IVC filter may be recommended.

Inferior vena cava syndrome

Inferior vena cava syndrome (IVCS) is a constellation of symptoms resulting from obstruction of the inferior vena cava. It can be caused by physical invasion or compression by a pathological process or by thrombosis within the vein itself. It can also occur during pregnancy. Pregnancy leads to high venous pressure in the lower limbs, decreased blood return to the heart, decreased cardiac output due to obstruction of the inferior vena cava, sudden rise in venous pressure which can lead to placental separation, and a decrease in renal function. All of these issues can arise from lying in the supine position during late pregnancy which can cause compression of the inferior vena cava by the uterus. Symptoms of late pregnancy inferior vena cava syndrome consist of intense pain in the right hand side, muscle twitching, hypotension, and fluid retention.

Inferior epigastric artery Blood vessel

In human anatomy, inferior epigastric artery refers to the artery that arises from the external iliac artery and anastomoses with the superior epigastric artery. Along its course, it is accompanied by a similarly named vein, the inferior epigastric vein. These epigastric vessels form the lateral border of Hesselbach's triangle, which outlines the area through which direct inguinal hernias protrude.

Falciform ligament

The falciform ligament is a ligament that attaches the liver to the anterior (ventral) body wall, and separates the liver into the left medial lobe and left lateral lobe. The falciform ligament, from Latin, meaning 'sickle-shaped', is a broad and thin fold of peritoneum, its base being directed downward and backward and its apex upward and backward. The falciform ligament droops down from the hilum of the liver.

Round ligament of liver

The round ligament of the liver is a degenerative string of tissue that exists in the free edge of the falciform ligament of the liver. The round ligament divides the left part of the liver into medial and lateral sections.

The cruciate anastomosis is a circulatory anastomosis in the upper thigh of the inferior gluteal artery, the lateral and medial circumflex femoral arteries, and the first perforating artery of the profunda femoris artery. Also, the anastomotic branch of the posterior branch of the obturator artery. The cruciate anastomosis is clinically relevant because if there is a blockage between the femoral artery and external iliac artery, blood can reach the popliteal artery by means of the anastomosis. The route of blood is through the internal iliac, to the inferior gluteal artery, to a perforating branch of the deep femoral artery, to the lateral circumflex femoral artery, then to its descending branch into the superior lateral genicular artery and thus into the popliteal artery.

Superficial epigastric artery Large blood vessel

The superficial epigastric artery arises from the front of the femoral artery about 1 cm below the inguinal ligament, and, passing through the femoral sheath and the fascia cribrosa, turns upward in front of the inguinal ligament, and ascends between the two layers of the superficial fascia of the abdominal wall nearly as far as the umbilicus.

Valve of inferior vena cava

The valve of the inferior vena cava is a venous valve that lies at the junction of the inferior vena cava and right atrium.

Superficial circumflex iliac artery blood vessel

The superficial iliac circumflex artery, the smallest of the cutaneous branches of the femoral artery, arises close to the superficial epigastric artery, and, piercing the fascia lata, runs lateralward, parallel with the inguinal ligament, as far as the crest of the ilium.

An atriocaval shunt (ACS) is an intraoperative surgical shunt between the atrium of the heart and the inferior vena cava. It is used during the repair of larger juxtahepatic vascular injuries such as an injury to the local vena cava. Injuries to the inferior vena cava are challenging, those behind the liver being the most difficult to repair.

Lobes of liver

The liver is grossly divided into two portions – a right and a left lobe, as viewed from the front (diaphragmatic) surface; but the underside shows it to be divided into four lobes and includes the caudate and quadrate lobes.

References

This article incorporates text in the public domain from page 670 of the 20th edition of Gray's Anatomy (1918)

The public domain consists of all the creative works to which no exclusive intellectual property rights apply. Those rights may have expired, been forfeited, expressly waived, or may be inapplicable.

<i>Grays Anatomy</i> English-language textbook of human anatomy

Gray's Anatomy is an English language textbook of human anatomy originally written by Henry Gray and illustrated by Henry Vandyke Carter. Earlier editions were called Anatomy: Descriptive and Surgical and Gray's Anatomy: Descriptive and Applied, but the book's name is commonly shortened to, and later editions are titled, Gray's Anatomy. The book is widely regarded as an extremely influential work on the subject, and has continued to be revised and republished from its initial publication in 1858 to the present day. The latest edition of the book, the 41st, was published in September 2015.