Part 68

The =inferior petrosal sinuses= (S. petrosi inferiores)[172] lie along the borders of the basilar part of the occipital bone, inclosed in the thick dura which closes the foramen lacerum. The anterior part extends about half an inch (ca. 12 mm.) under the temporal wing of the sphenoid. Here communications exist with veins in the pterygo-palatine fossa. The posterior end is bulbous and lies in the condyloid fossa; it communicates with the condyloid vein issuing from the hypoglossal foramen and is drained by the inferior cerebral vein; it also receives an emissary vein from the parieto-temporal canal. The roof of the sinus is perforated by an oval opening at the carotid notch which opens into the cavernous sinus and transmits the internal carotid artery; the latter forms the first bend of its =S=-shaped curve in the petrosal and the second in the cavernous sinus.

The =basilar plexus= (Plexus basilaris) is a venous plexus situated on the upper surface of the basilar part of the occipital bone. It is connected through the hypoglossal foramen with the inferior petrosal sinus and communicates behind with the spinal veins.

THE VEINS OF THE CRANIUM

The =veins of the brain= (Venæ cerebri) do not in general accompany the cerebral arteries. They have very thin walls, no muscular coat, and no valves. They are arranged in two sets, superficial or cortical and deep or central. The superficial veins are more numerous and larger than the arteries. They lie on the surface of the brain in the pia mater and the subarachnoid space.

The =superior cerebral veins= drain the upper and outer part of the cerebral cortex. They receive veins from the medial surfaces of the hemispheres and open into the superior sagittal sinus. Their terminal parts are bulbous and their openings are directed obliquely forward, _i. e._, contrary to the direction of the bloodstream in the sinus.

The =inferior cerebral veins= lie on the inferior and external aspect of the hemispheres. They open into the inferior system of sinuses. The =middle cerebral vein= runs in the lateral fissure (of Sylvius) and opens into the cavernous sinus.

The =deep cerebral veins= issue from the central or ganglionic parts of the brain at the transverse fissure. They converge to form the =great cerebral vein= (of Galen) (V. magna cerebri). This passes upward and backward behind the splenium of the corpus callosum and is continued as the straight sinus to join the sagittal sinus.

The =superior cerebellar veins= ramify on the upper surface of the cerebellum. They open into the superior system of sinuses and the great cerebral vein. The =inferior cerebellar veins= are larger and go chiefly to the basilar plexus. The veins of the medulla and pons end in the inferior system of sinuses.

The =meningeal veins= (Venæ meningeæ) arise in capillary plexuses in the superficial and deep faces of the dura mater. Some end in the sinuses of the dura, others accompany the meningeal arteries.

The =diploic veins= (Venæ diploicæ) are anastomosing channels in the spongy substance of the cranial bones. Their walls are thin, consisting in many places only of the endothelium, and they have no valves. Some open inward into venous sinuses, others into extracranial veins.

SPINAL VEINS

Two =longitudinal spinal veins= or =sinuses= (Sinus columnæ vertebralis) extend along the floor of the vertebral canal, one on either side of the superior common ligament. They are continuous in front with the basilar plexus. They lie in the grooves on the bodies of the vertebræ and are connected by a series of transverse anastomoses which pass between the central part of the bodies of the vertebræ and the superior common ligament or in channels in the bone. They receive veins from the spinal cord, the dura mater, and the bodies of the vertebræ (Venæ basis vertebræ). Through the intervertebral foramina efferent vessels connect with the vertebral, intercostal, lumbar, and lateral sacral veins.

VEINS OF THE THORACIC LIMB

The =brachial vein= (V. brachialis) is a satellite of the extrathoracic part of the brachial artery. It arises at the inner side of the distal end of the shaft of the humerus and passes upward in the arm behind the artery under cover of a layer of fascia and the posterior superficial pectoral muscle. At the shoulder it is ventral to the artery, crosses the anterior border of the first rib, and concurs with its fellow and the two jugulars in the formation of the anterior vena cava. The roots of the vein are somewhat variable, but most often four radial veins in addition to a large oblique branch from the cephalic unite in its formation. Its tributaries correspond in general to the branches of the artery, but a few differences are worthy of notice. The =thoracico-dorsal vein= joins the brachial directly or opens into the deep brachial. The =external thoracic= or =“spur” vein= (V. thoracica externa) is a large vessel which arises in the ventral wall of the abdomen, passes forward (embedded more or less in the panniculus) along the outer border of the posterior deep pectoral muscle, and joins the brachial vein near the first rib. It often communicates with the subscapular vein.

The =cephalic vein= (V. cephalica) arises at the inner side of the carpus as the continuation of the internal superficial metacarpal vein. It runs upward on the deep fascia of the forearm at first in the furrow between the flexor carpi internus and the radius. Toward the middle of the forearm it inclines gradually forward on the inner surface of the radius, accompanied by a cutaneous branch of the median nerve, and arrives at the insertion of the biceps. Here it detaches a large branch (Ramus communicans) which passes upward and backward over the inner insertion of the biceps, the posterior radial artery, and the median nerve, and joins the brachial vein. The vein to this point is often termed the internal subcutaneous vein of the forearm (V. cephalica antebrachii). It is continued (as the V. cephalica humeri) in the furrow between the mastoido-humeralis and the anterior superficial pectoral with a branch of the inferior cervical artery, crosses the deep face of the cervical panniculus, and opens into the terminal part of the jugular or the brachial vein. It receives an =accessory cephalic vein= (V. cephalica accessoria), which arises from the carpal network, runs upward along the inner border of the extensor carpi, turns along the lower border of the brachialis, passes under the superficial tendon of the biceps and joins the cephalic.

The deep veins of the forearm are variable. Commonly two =posterior radial veins= (Venæ medianoradiales) accompany the artery of like name, one in front and one behind. A third vein arises by radicles emerging from the proximal part of the deep flexor; it joins the posterior satellite of the posterior radial artery or forms one of the roots of the brachial vein. The =common interosseous vein= joins the posterior satellite. The =anterior radial vein= (V. collateralis radialis) is a satellite of the artery. The =ulnar vein= is usually double at its proximal part, and communicates with the deep brachial vein.

There are three chief =metacarpal veins=. The =internal metacarpal vein= (V. metacarpea volaris superficialis medialis) arises from the volar venous arch above the fetlock. It is the largest vein of the region and lies in front of the large metacarpal artery. It separates from the artery at the proximal end of the metacarpus, passes upward on the inner part of the posterior surface of the carpus, under cover of the superficial layer of the posterior annular ligament, and is continued as the cephalic vein. It communicates at its proximal part with the origin of the posterior radial veins by a short but relatively large branch. The =external metacarpal vein= (V. metacarpea volaris superficialis lateralis) arises from the venous arch above the fetlock and passes upward behind the external border of the suspensory ligament in front of the external branch of the median nerve and accompanied by a small artery. At the proximal end of the metacarpus it is connected with the deep metacarpal vein by two transverse anastomoses which pass across the suspensory ligament. It then passes upward as a satellite of the external volar metacarpal artery and concurs in the origin of the ulnar and posterior radial veins. The =deep metacarpal vein= (V. metacarpea volaris profunda medialis) arises from the venous arch, passes forward between the two branches of the suspensory ligament, and ascends on the posterior surface of the large metacarpal bone. At the proximal end of the latter it communicates with the other metacarpal veins, ascends with the small metacarpal artery, and concurs in forming the radial veins.

The =venous arch= (Arcus venosus volaris), from which the metacarpal veins arise, is situated above the sesamoids of the fetlock between the suspensory ligament and the deep flexor tendon. It is formed by the junction of the two digital veins.

The =digital veins=, internal and external (V. digitalis medialis, lateralis), drain the venous plexuses of the foot. They arise at the upper edge of the lateral cartilages and ascend in front of the corresponding arteries.

It is convenient to recognize the following venous plexuses of the foot, which, however, communicate very freely:

1. The =coronary plexus= encircles the upper part of the foot. It is attached to the terminal part of the extensor tendon, the lateral cartilages, and the bulbs of the plantar cushion.

2. The =dorsal= (or laminal) =plexus= covers the dorsal or wall surface of the third phalanx in the deep layer of the matrix of the wall of the hoof. It forms the circumflex vein of the third phalanx or vein of the distal border of the third phalanx, which corresponds to the artery of like name.

3. The =volar plexus= is in the deep layer of the matrix of the sole of the hoof and on the deep surface of the lateral cartilages. It communicates around the inferior border of the third phalanx with the dorsal plexus and through the lateral cartilages with the coronary plexus.

The deep vein of the third phalanx accompanies the terminal part of the digital artery. It drains the =intraosseous plexus=.

THE POSTERIOR VENA CAVA (Figs. 270, 450)

The =posterior vena cava= (V. cava caudalis) returns almost all of the blood from the abdomen, pelvis, and pelvic limbs. It is formed by the confluence of the right and left common iliac veins at the fifth lumbar vertebra, above the terminal part of the aorta and chiefly to the right of the median plane.

The mode of origin is variable. In some cases there is a common trunk formed by the union of the two internal iliac veins so that the arrangement resembles the termination of the aorta. In other cases the internal iliac vein does not exist.

It passes forward on the ventral face of the psoas minor to the right of the abdominal aorta. At the last thoracic vertebra it separates from the aorta and runs forward between the right crus of the diaphragm and the pancreas till it reaches the liver. Here it inclines downward along the inner border of the right lobe and the parietal surface of the liver, largely embedded in the gland substance, and passes through the foramen venæ cavæ of the diaphragm. It then runs forward and somewhat downward between the mediastinal lobe and the main mass of the right lung at the upper margin of a special fold of the right pleura, accompanied by the right phrenic nerve, and opens into the posterior part of the right atrium. It receives the following tributaries:

1. The =lumbar veins= (Vv. lumbales) correspond to the arteries. Five pairs usually empty into the vena cava. Sometimes the corresponding veins of opposite sides unite to form a common trunk. The first communicate with the vena azygos.

2. The =spermatic veins= (Vv. spermaticæ internæ) (Fig. 450) accompany the arteries of like name. In the spermatic cord they form the pampiniform plexus about the artery and nerves. Their termination is variable. The right one commonly joins the vena cava near the renal vein, often by a common trunk with the left one. Frequently the left vein joins the left renal, and sometimes the right one ends similarly.

2_a_. The =utero-ovarian veins= are much larger than the preceding and are satellites of the arteries in the broad ligaments. The ovarian branch is plexiform near the ovary. The uterine branches form a rich plexus in the wall of the uterus. The trunk is very short.

3. The =renal veins= (Vv. renales), satellites of the arteries, are of large caliber and thin-walled. The right vein passes inward and backward on the ventral face of the kidney between the artery in front and the ureter behind. It joins the vena cava above the right adrenal. The left vein is somewhat longer. It passes inward at first like the right one, then bends around the posterior end of the adrenal, crosses the origin of the renal artery and opens into the vena cava a little further back than the right one. They receive veins from the adrenals, but some adrenal veins open directly into the vena cava.

4. The =hepatic veins= (Vv. hepaticæ) return the blood from the liver, and open into the vena cava as it lies in the groove in the liver. Three or four large vessels open into the vena cava just before it leaves the liver, and numerous small ones discharge into its embedded part.

5. The =phrenic veins= (Vv. phrenicæ), two or three in number, return the blood from the diaphragm. They are very large in comparison with the arteries, and join the vena cava as it lies in the caval opening.

In some cases there is a small middle sacral vein (V. sacralis media), a satellite of the artery. It opens into the angle of junction of the common iliac veins or into one of the latter.

THE PORTAL VEIN

The =portal vein= (V. portæ) is a large trunk which returns the blood carried to the viscera by the gastric, splenic, and mesenteric arteries. Its peripheral tributaries correspond closely with the branches of the arteries, but the terminal trunks do not. The vein is formed behind the pancreas and below the posterior vena cava by the confluence of the =anterior= and =posterior mesenteric= and =splenic veins=. It passes forward, traverses the posterior part of the pancreas very obliquely, inclines ventrally and a little to the right, and reaches the portal fissure of the liver. Here it divides into three branches which enter the liver and ramify in the substance of the gland like an artery, terminating in the lobular capillaries. From the lobules the blood passes into the hepatic veins and through these to the posterior vena cava. Thus the blood which is distributed to the stomach, nearly the entire intestinal tract, the pancreas, and the spleen, passes through two sets of capillaries prior to its return to the heart, viz., the capillaries of these viscera and of the liver.

1. The =anterior mesenteric vein= (V. mesenterica cranialis) is the largest of the portal radicles. It is situated to the right of the artery of like name, and its tributaries correspond in general to the branches of the artery. Usually a single colic vein corresponds to the two arteries of the right portions of the colon.

2. The =posterior mesenteric vein= (V. mesenterica caudalis) is the smallest of the radicles of the portal. It accompanies the artery in the colic mesentery and its rectal branches anastomose with those of the internal pudic vein.

3. The =splenic vein= (V. lienalis) is the very large satellite of the splenic artery. It is formed by the union of two radicles at the base of the spleen. On leaving the hilus of the spleen it passes inward between the anterior pole of the left kidney and the saccus cæcus of the stomach and above the left end of the pancreas, receives commonly the =posterior gastric vein= (V. gastrica caudalis), and unites with the anterior mesenteric at the posterior border of the pancreas.

The collateral tributaries of the portal veins are as follows:

(1) =Pancreatic veins= (Rami pancreatici).

(2) The =gastro-duodenal vein= (V. gastroduodenalis) corresponds mainly to the extrahepatic branches of the hepatic artery.

(3) The =anterior gastric vein= (V. gastrica cranialis) joins the portal at the portal fissure.

THE COMMON ILIAC VEINS (Fig. 456)

These (V. iliacæ communes) are two very large but short trunks which result from the union of the internal and external iliac veins of each side at the sacro-iliac articulation. The left one is the longer and crosses obliquely over the terminal part of the aorta. The chief tributaries of each are as follows:

1. The last =lumbar vein=.

2. The =circumflex iliac veins= (Vv. circumflexæ ilium profundæ) are the two satellites of each corresponding artery, on either side of which they are placed. They may open directly into the posterior vena cava or into the external iliac vein.

3. The =ilio-lumbar vein= (V. iliolumbalis) may open into the common iliac, the external iliac, or the internal iliac vein.

THE INTERNAL ILIAC VEINS

The =internal iliac= or =hypogastric veins= (Vv. hypogastricæ), right and left, are usually formed by the confluence of lateral sacral, gluteal, and internal pudic veins. The obturator vein may open into them also. They are short trunks and are smaller than the external iliac veins. The tributaries correspond in general to the branches of the three arteries of like names. The internal pudic veins receive affluents from the venous plexuses of the prepuce and penis in the male; of the mammary gland, vulva, vagina, and vestibular bulb in the female.

THE VEINS OF THE PELVIC LIMB

The =external iliac vein= (V. iliaca externa) (Figs. 450, 451) lies behind the corresponding artery at the brim of the pelvis. It is the upward continuation of the femoral vein, and unites at the sacro-iliac joint with the internal iliac to form the common iliac vein. Its tributaries are as follows:

1. The =obturator vein= (V. obturatoria) is a satellite of the artery and usually opens into the external iliac at the insertion of the psoas minor. Its radicles anastomose with those of the internal and external pudic veins (Figs. 451, 455).

2. The =iliaco-femoral= or =external circumflex veins= (Vv. circumflexæ femoris laterales) are the two satellites of the homonymous artery. They open a little higher than the obturator.

The =femoral vein= (Figs. 450, 451) lies behind the artery in the upper part of the thigh, external to it lower down. Its chief tributaries are:

1. A very large but short trunk formed by the union of the deep femoral and the external pudic vein. The =deep femoral vein= (V. profunda femoris) corresponds otherwise to the artery. The =external pudic vein= (V. pudenda externa) arises chiefly from a rich plexus of large veins situated above and along the sides of the penis and prepuce in the male, the mammary glands in the female. It passes through a foramen in the anterior part of the tendon of origin of the gracilis and runs outward in the subpubic groove behind the pectineus to unite with the deep femoral vein. The right and left veins are connected by a large transverse anastomosis and each has a large connection with the obturator vein. Each receives the =posterior abdominal vein= (V. epigastrica caudalis) which accompanies the artery of like name. The =subcutaneous abdominal vein= (V. abdominalis subcutanea) arises in the skin and panniculus of the ventral abdominal wall, anastomoses with the internal and external thoracic and deep abdominal veins, and joins the external pudic or posterior abdominal vein.

A small vein accompanies the external pudic artery in the inguinal canal.

2. The =anterior femoral vein= (V. femoris cranialis) accompanies the artery.

3. The =saphenous vein= (V. saphena) (Figs. 451, 458, 460) arises at the inner side of the flexion surface of the tarsus as the upward continuation of the internal metatarsal vein. Its course is distinctly visible. It ascends on the subcutaneous surface of the tibia and the popliteus muscle, inclosed between layers of the deep fascia, inclines a little backward to the proximal part of the leg, then deviates slightly forward, runs upward on the gracilis, passes between that muscle and the sartorius, and joins the femoral or the external pudic vein.[173] On the upper part of the capsule of the hock joint it forms an arch with the anterior tibial vein. The vein has numerous valves. The satellite artery is relatively small and lies in front of the vein as far as the junction with the recurrent tibial vein, which it accompanies on the leg. It receives the =recurrent tibial vein= (V. recurrens tibialis)[174] at the proximal fourth of the leg. This vessel arises at the inner surface of the tarsus and forms an arch with the posterior tibial vein at the level of the tuber calcis. It ascends in the furrow in front of the gastrocnemius tendon, inclines forward at the proximal third of the leg, and joins the saphenous vein at an acute angle. It has numerous valves. A smaller vein from the anterior face of the metatarsus joins the saphenous at the hock.

4. =Muscular branches= which correspond to the arteries.

5. The =posterior femoral= or =femoro-popliteal= vein (V. femoris caudalis) is a satellite of the artery. It receives the =recurrent tarsal= or =external saphenous vein= (V. tarsea recurrens), which arises at the outer side of the hock, ascends on the deep fascia of the external surface of the leg in front of the tendo Achillis, passes between the biceps femoris and semitendinosus, and joins the posterior femoral vein. It is connected with the recurrent tibial vein by a large anastomotic branch which crosses in front of the tuber calcis. Usually a branch from it ascends along the great sciatic nerve and anastomoses with the obturator vein.

The =popliteal vein= (V. poplitea) lies along the inner side of the artery (Fig. 459). It is formed by the confluence of anterior and posterior tibial veins.