Diagnostic ultrasound ( PDFDrive )

CHAPTER 27 Peripheral Vessels 981
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B
FIG. 27.23 Pulmonary Emboli. (A) Axial CT with contrast shows a large saddle pulmonary embolus extending into the left and right pulmonary
arteries (arrows). (B) Maximum-intensity projection coronal CT with contrast in the same patient shows extent of bilateral pulmonary emboli (arrows).
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B
C
D
E
Common femoral
vein
Great saphenous
vein
Profunda femoris
vein
Femoral vein
Adductor magnus
muscle
Adductor canal
Popliteal vein
Anterior tibial
veins
Small saphenous vein
Peroneal veins
Posterior tibial veins
FIG. 27.24 Venous Anatomy of the Lower Extremity.
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B
C
D
E
to the artery and courses through the popliteal space into the
proximal calf. Duplication of the FV can be seen in about 30%
of patients. 78 Duplication of the FV can also be segmental. It has
been shown that these anatomic variants are associated with
increased incidence of DVT. 79,80 About 40% of patients with multiple
vessels within the popliteal fossa arise from a high conluence of
the posterior tibial and peroneal veins, rather than true PV
duplication. 78 Description of these anatomic variants assists in
avoiding a missed diagnosis on follow-up examinations.
he paired anterior tibial veins arise from the PV and course
laterally along the anterior calf to the dorsum of the foot. he
tibioperoneal trunk originates from the PV slightly caudal to
the anterior tibial veins and bifurcates into the paired posterior
tibial veins and peroneal veins. he peroneal veins course medial
to the posterior aspect of the ibula, whereas the posterior tibial
veins course through the posterior calf muscles posterior to the
tibia and along the medial malleolus. Deep veins in the gastrocnemius
and soleus calf muscles do not have an adjacent artery
and are a common site of acute calf vein thrombus in postoperative
or high-risk patients. 81
Supericial Venous System. Anatomic terminology for
the lower extremity supericial venous system was standardized
in 2002. he great and small saphenous veins and their branches
comprise the supericial venous system of the lower extremities. 82
he great saphenous vein (GSV) empties into the medial aspect
of the CFV in the proximal thigh superior to the bifurcation of
the CFV. he GSV courses along the medial thigh and calf. he
normal GSV typically is 1 to 3 mm in diameter at the level of
the ankle and 3 to 5 mm in diameter at the saphenofemoral
junction. hese measurements are important when performing
saphenous vein mapping for harvesting an autologous vein grat.
he small saphenous vein has a variable insertion into the
posterior aspect of the PV and courses along the dorsal calf to
the ankle. Measurements for the small saphenous vein are typically