Superficial Femoral Vein

Four main groups of collateral thoracic veins include azygos system of veins -communication between SVC and ascending lumbar vein subfascial system of epigastric veins - collateral circulation between brachiocephalic vein and external femoral vein subcutaneous system of superficial epigastric vein and vertebral veins. Less frequently, systemic-pulmonary or intramuscular pathways are involved. 

Subcutaneous veins of the trunk connect axillary and femoral veins (Figure 3). Superficial system anastomoses with the subfascial system by means of perforating veins, which carry blood from medial aspect of breasts and sternal branches of internal thoracic veins. 

Fig. Anatomy and landmarks for cannulating the femoral vein. The femoral vein should be cannulated at or just above the inguinal crease. A low cannulation point should be avoided because there is an increased risk of puncturing the superficial femoral artery.

The superficial venous system of the lower extremities is composed of innumerable subcutaneous collecting veins, the saphenous trunks and their tributaries. The CSV begins on the anterior and medial portion of the foot, runs anterior to the medial malleolus, and ascends the medial aspect of the calf and thigh to ultimately join the femoral vein at the fossa ovale (saphenofemoral junction, SFJ) several centimeters below the inguinal ligament (Fig. 9.1). The CSV is adjacent to the saphenous nerve (sensory)... 

Fig. 9.2. Longitudinal view of the saphenofemoral junction (SFJ) during positioning of a laser fiber prior to EVTA. The left of the image is toward the patient s head. A thin arrow points to the tip pf the laser fiber approximately 5-10 mm below the SFJ at the takeoff of the superficial epigastic vein. The ( ) identifies the SFJ, FV the femoral vein, GSV the great saphenous vein and SEG the superficial epigastric vein...

Fig. 12.17. Intrapelvic portion of the iliopsoas muscle. Transverse 12-5 MHz US image obtained over the intrapelvic portion of the iliopsoas (IPs) muscle in a healthy subject. The muscle is seen lying over the anterior surface of the iliac bone. Its tendon (arrow) is located in an anterior and medial position. It appears as a well-defined oval hyperechoic structure embedded within the hypoechoic muscle belly. The femoral nerve (FN) is found in a superficial location, just laterally to the common femoral artery (FA). FV, femoral vein. The photograph and the schematic drawing at the left side of the figure indicate probe positioning...

Fig. 13.11a,b Adductor hiatus. Transverse a gray-scale and b color Doppler 12-5 MHz US images over the lower third of the medial thigh demonstrate the superficial femoral artery open arrowhead) and vein white arrowhead), and the saphenous nerve open arrow) which course underneath the aponeurosis white arrow) of the adductor magnus (AM). Note the sartorius muscle (Sa) which lies superficial to the femoral neurovascular bundle. The insert at the upper left of the figure indicates probe positioning... 

Sentinel node biopsy, which has been extensively validated in breast cancer and melanoma, is being used increasingly in the evaluation of penile cancer. The concept of the sentinel node, the first lymph node to contain metastatic cancer within a tumor s lymphatic basin, was introduced by Cabanas in 1977 (Cabanas 1977). Anatomically, the sentinel lymph node was discovered to be part of the lymphatic system around the superficial inferior epigastric vein, and theoretically, skip metastases beyond this node were suppose to be a very rare event. Cabanas recommended bilateral sentinel node biopsy followed by inguino-femoral dissection only when biopsy of the sentinel node was positive. When the sentinel node is negative for metastatic disease, no further surgical treatment was recommended. The reliability of Cabana s approach was limited by its relatively poor localization technique, and therefore failed to gain widespread acceptance. 

In the presence of rapid venous drainage or massive venous spaces, placement of coils can be useful to retain sclerosing agent and avoid pulmonary embolus, particularly in a venous malformations close to normal veins. Coils can be delivered directly through the access needle into the venous spaces or via the femoral or jugular vein (Fig. 2. lOa-e). For limb superficial venous malformations, a peripheral intravenous catheter can be useful to perform a phlebography during sclerotherapy for assess-... 

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