Femoral vein

Structure

The femoral vein bears valves which are mostly bicuspid and whose number is variable between individuals and often between left and right leg.

Course

The femoral vein continues into the thigh as the continuation from the popliteal vein at the back of the knee. It drains blood from the deep thigh muscles and thigh bone. Proximal to the confluence with the deep femoral vein, and the joining of the great saphenous vein, the femoral vein is widely known as the common femoral vein. As the common femoral vein leaves the inguinal ligament region it becomes the external iliac vein. Other tributaries of the femoral vein are lateral and medial circumflex femoral veins.

The common femoral vein is the segment of the femoral vein between the branching point of the deep femoral vein and the inferior margin of the inguinal ligament. It is not listed in Terminologia Anatomica, which is the international standard for human anatomical terminology developed by the Federative International Programme on Anatomical Terminology. However, it was thought to be due for inclusion in the next edition following consensus documents presented in 2001 at the 14th World Congress of the International Union of Phlebology, and in 2004 at the 21st World Congress of the International Union of Angiology. These consensus documents were brought about by the need felt for more clarity and expansion of terms.

Distal segment

In the past, the femoral vein was seen to follow the superficial femoral artery a name used to distinguish the femoral artery from the deep femoral artery; as per the norm of naming veins to match their artery the femoral vein was called the superficial femoral vein. This was a potentially harmful misnomer since the femoral vein is a deep vein and not a superficial vein, and thus a possible site for a deep vein thrombosis, that may be overlooked as a superficial vein for anticoagulant therapy.

Because of the widespread misunderstanding, and possible harmful results from the use of superficial femoral vein, a consensus was arrived at in 2001 during the World Congress of the International Union of Phlebology to change the name from superficial femoral vein simply to femoral vein. This has been widely recognised and adopted though the use of superficial femoral vein still persists in some sources. Its use is actively discouraged. It has been suggested that another term be used – the subsartorial vein. A previous usage of subsartorial artery was published to avoid the name superficial femoral vein from being used. As per the consensus of 2002, the superficial femoral artery was unchanged.

Tributaries

The great saphenous vein, and the deep femoral vein are two large tributaries that drain into the femoral vein which then becomes known as the common femoral vein. Other smaller vein tributaries are the lateral and medial circumflex femoral veins. These circumflex veins follow the lateral circumflex femoral artery, and the medial circumflex femoral artery.

Clinical significance

The femoral vein is a common site for a deep vein thrombosis. This can be a proximal DVT in the femoral vein, or more proximal as an iliofemoral DVT usually associated with the common femoral vein. An iliofemoral DVT carries a greater risk of a pulmonary embolism developing.

The femoral vein is often used to place a central venous catheter, or line for venous access. Ultrasound imaging for locating the vein and catheter placement is advocated over the use of anatomical landmarks due to the possible presence of anatomical variants. This is associated with a significant risk of infection.

The practice of delivering recreational drugs intravenously using the femoral vein in the groin is relatively common amongst injecting drug users.

Additional images

File:Gray432 color.png|Position of femoral vein and artery in adductor canal File:Gray344.png|Structures surrounding right hip-joint. File:Gray545.png|Femoral sheath laid open to show its three compartments. File:Slide9CCCC.JPG|Femoral vein

References

References

1. (2018). "Femoral vein diameter, valve and tributary topography in humans - a post mortem analysis". [[Clinical Anatomy]].
2. (2011). "Human anatomy". McGraw-Hill.
3. "Femoral vein {{!}} Radiology Reference Article {{!}} Radiopaedia.org".
4. (April 2017). "Ultrasonography of the lower extremity veins: anatomy and basic approach.". Ultrasonography (Seoul, Korea).
5. Craig Hacking. (2019-08-26). "Common femoral vein".
6. Reva Arnez Curry, Betty Bates Tempkin. (2014). "Sonography - E-Book: Introduction to Normal Structure and Function". Elsevier Health Sciences.
7. (March 2012). "The deep venous system of the lower extremity: new nomenclature.". Phlebology.
8. (June 2010). "The superficial venous system of the lower extremity: new nomenclature.". Phlebology.
9. Caggiati A, Bergan JJ, Gloviczki P, Jantet G, Wendell-Smith CP, Partsch H. (2002). "Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement.". J Vasc Surg.
10. (March 2010). "Information on the changes in the revised anatomical nomenclature of the lower limb veins.". Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia.
11. Amarnath C and Hemant Patel. (2023). "Comprehensive Textbook of Clinical Radiology - Volume III: Chest and Cardiovascular system". [[Elsevier]] Health Sciences.
12. Hammond I. (Nov 2003). "The superficial femoral vein". Radiology.
13. (1 April 2005). "Nomenclature of the veins of the lower limb: Extensions, refinements, and clinical application". Journal of Vascular Surgery.
14. Kitchens CS. (2011). "How I treat superficial venous thrombosis.". Blood.
15. (2011). "Use of the term "superficial femoral vein" in ultrasound.". J Clin Ultrasound.
16. (October 1995). "The superficial femoral vein. A potentially lethal misnomer". JAMA.
17. Mikael Häggström. (2019). "Subsartorial Vessels as Replacement Name for Superficial Femoral Vessels". International Journal of Anatomy, Radiology and Surgery.
18. Amarnath C and Hemant Patel. (2023). "Comprehensive Textbook of Clinical Radiology - Volume III: Chest and Cardiovascular system". [[:en:Elsevier.
19. Antoine Micheau, MD. "Superficial femoral artery".
20. (July 2019). "Venous Nomenclature". Journal of Diagnostic Medical Sonography.
21. "Femoral Vein: Anatomy & Function".
22. (2014). "Deep Venous Thrombosis: An Interventionalist's Approach". Ochsner J.
23. (28 August 2017). "Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice.". Critical Care.
24. (2007-01-01). "Chapter 204 - Central Venous Access". Mosby.
25. (2009-01-01). "CHAPTER 25 - Vascular access". Churchill Livingstone.
26. Kern, Winfried V.. (2017-01-01). "48 - Infections Associated with Intravascular Lines and Grafts". Elsevier.
27. (April 2005). "Use of the femoral vein ('groin injecting') by a sample of needle exchange clients in Bristol, UK". Harm Reduct J.