Valves of the Venous System of the Lower Extremities, Pelvis & Abdomen

S. Lakhanpal MDPresident & CEO

Center for Vein Restoration

Histology of a Venous Valve

– The Venous Valves:• Bicuspid infoldings of the intima covered by

endothelium on both sides with an intervening connective tissue skeleton.• At the origin of these valves veins may be

focally distended forming small sinusoid dilatations in response to the hemodynamic consequences of focally reversed flow.

Valves Assisting One Way Flow

The Venous Valves:Bicuspid inholdings of the intima covered by endothelium on both sides with an intervening connective tissue skeletonAt the origin of these valves veins may be focally distended forming small sinusoid dilatations in response to the hemodynamic consequences of focally reversed flow.

Vein Valve Mechanisms

Location and No. of Valves

• Deep Veins of the Lower Extremity– Frequency increases from proximal to distal.– Deep veins of the foot, posterior and anterior tibial, peroneal are profusely

valved at every 2 cm interval.– The popliteal vein and the distal femoral vein usually have 1-2 valves.– The more proximal part of the femoral vein up to its junction with the

profunda vein -three or more, with one just distal to the junction.– In the CFV there is usually just one valve.– EIV and CFV proximal to the SFJ 1 or none.

• Common Iliac and IVC– Usually no valves.

• Perforating Veins– Valves direct blood flow from superficial to deep.

Valves in the Deep Veins

• The number of deep venous valves increases from cranial to caudal. • Unlike the infrainguinal veins, the iliac veins rarely contain valves. • There are on average five deep venous valves between the inguinal

ligament and popliteal fossa, although the number varies from two to nine.

• The external iliac and common femoral vein above the saphenofemoral junction usually have one valve at most; the femoral vein above the adductor canal has three or more valves; the distal femoral and popliteal veins have one or two valves; and the tibial/peroneal veins have numerous valves spaced at 12-cm intervals.

• Relatively constant stations include a valve in the femoral vein just distal to its confluence with the deep femoral vein and in the popliteal vein just distal to the adductor canal. Competence of the popliteal valves is particularly important to calf muscle pump function.

Ovarian Vein - Anatomy

• Provide drainage to the– Parametrium, cervix, mesosalpinx,

pampiniform plexus.• Forms a rich anastomotic venous plexus

with the:– Paraovarian, uterine, vesical, rectal and

vulvar plexus.• 2-3 trunks form a single ovarian vein at L4.

– Left ovarian vein drains into the LRV– Right Ovarian vein drains into the IVC

» 10% ROV’s drain into the RRV

– The ovarian veins have an average diam. of 5mm.

• Valves are present mainly in the distal third– Absence of valves in 15% on the left

side and 6% on the right side.

Ahlberg NE, Bartley O, Chidekel N. Right and left gonadal veins. Ananatomical and statistical study. Acta Radiol Diagn (Stockh) 1966;4: 593-601.

Ovarian Vein - Anatomy

Location and No. of Valves

• Superficial venous system of the lower extremity– More constant valves at the termination of a trunk other

valves st transparentare delicate almost transparent.• GSV

– Usually at least 6 valves (14-25), with a constant valve between 2-3 cms from the SFJ(85%)

– The frequency of valves is greater below the knee• SSV

– More numerous (median 7-10) Range 4-13. Highest valve is close to the termination of the SSV

• SSV GSV connections– Directs from SSV to GSV

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