­­­The deep­ veins, although posterior in their appearance with the surface veins acquired in the adult, by the development of the muscular masses, a volume usually higher than that of the subcutaneous veins.

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­With rare exceptions, they are rigorously satellite arteries and are in a double number of those. It is necessary this law to exclude the large trunks of the axillary and subclavian which are single, and the satellite small veins of small arteries which are often simple and finally veins aberrant which present through the muscles an independent way.

Their collateral is the same ones as those of the arteries; one finds difference only for the vessels of the fingers and the related branches of the subclavian. For all these reasons, the arteries being known, the description of the veins is very simplified. Add that deep veins have many anastomoses on all their way with superficial veins by many perforating branches with no valve, that they frequently present collateral channels or of safety which can easily impose some for the principal vein in the research of the vessels, finally that the valves are more numerous there than in the superficial veins. This difference in the number of the valves is especially marked in the child. Generally the collateral branches have with their mouth a pair of very resistant valves.

Deep veins of the hand

The hand preserved the embryonic venous type; the surface veins gain of much over the deep veins. These last are accurately satellite arteries and in a double number. There is thus on the back of the hand three or four pairs of dorsals interosseous, and in the surface palm a double arcade and a double deep arcade, formed similarly by the radial and cubital veins braided. With the deep arcade, whose two branches frame the arterial arcade, lead the deep interosseous veins, whose origins are in the first phalange and the interdigital fold; with the surface arcade, the common digital veins, which are formed by collateral deep fingers. The deep collateral veins are rudimentary vessels, out of proportion with the volume of their satellite arteries they bring back the blood of the fibrous parts, such as the sheaths of the flexor ones.

All these venous vessels are pointed out by their slenderness ratio; they have indeed only restricted origins, the sheaths, the tendons of flexor, the nerves, the lumbricals muscles and interosseous. Almost the totality of the blood of the skin of the fingers and the muscles of the thenar and hypothenar eminences flows in the dorsal veins surface. One can see in this provision, which contrasts with that of the arterial system, an effect of the operation of the hand; the palm of the hand and the fingers, bearing surface and gripping, is subjected to pressures which block the extension of the veins those always tend to develop in the direction of the least pressure and for that emigrated with the dorsal face.

The deep palmar veins are emptied partly in the formative branches of the arcades, i.e. in the radial and cubital veins, partly also in the subcutaneous dorsal veins; because there are many anastomoses which link the deep arcade with the dorsal veins, in particular perforating them of interosseous spaces, which lead at the origins of cephalic and the salvatelle one. The regular circulation sudden of temporary accelerations when the gripping of the objects is exerted; the hand pressing object-seized the vacuum the blood of its veins by the mechanism of the form of sponge.

Deep veins of before arm

Radial and the cubital deep ones, with their collateral branches, of which most considerable are the interosseouses ones, branches of cubital, constitute the veins of the front armlever. As they are double by each satellite artery, one distinguishes radial external and a radial intern, and so on. Anastomoses in scale of the two satellites are fewer than with the leg and become important only on the level of the elbow. The branches which are born from the long muscles (cubital, flexor, musculus supinator longus) usually present the type in successive arcades. The major part of the fold of the elbow is a venous confluence the convergence of the two principal trunks, the interosseous one, the recurring radial one and cubital, collateral channels and the communicating ones of the surface veins, and the varied combinations that all these vessels carry out while being linked between them, often produce a true plexus.

The radial ones are small, at their origin especially. One counted in one of the two satellites, 8, 9 and 12 valves. Cubital, the bulkier, originates in minus the surface palmar arcade which is very spindly, that the dorsal vein of the hand of which they receive blood by a large anastomosis.

Deep veins of the arm. Veins humérales

The two humeral veins, satellites of the artery, are born with the fold from the very variable elbow of manner, according to the irregular way in which the two radial ones combine and two the cubital deep ones which is its branches of origin. One distinguishes an external humeral and internal humeral this one usually larger, of a diameter of 8 millimeters, both connected by transverse anastomosis. It is good to note that in certain points of their way, in particular with the fold of the elbow or in the middle of the arm, places traditional of the bindings, one often sees one of the two humeral veins, most frequently the external one, to be placed in front of the artery of other times the veins surround the artery in spiral. The humeral veins are not always double on all their way. Often they meet in only one internal trunk or common humeral in the higher part of the arm: in this case, there is usually a collateral channel which continues the external humeral. One found in the humeral veins, 5, 8 and 15 valves.

The collateral branches are those of the artery: muscular of the biceps and the former brachial, collateral interns, collateral veins external or humeral deep usually bulky, and of in addition to a surface vein the basilica, which emerges in the higher part of the arm. Frequently and more or less close to the armpit, one observes a true plexus or venous confluence formed by the convergent meeting of the large deep numeral veins and the muscular veins in the humeral veins, which moreover are covered with their transverse anastomosis.

Axillary vein

The axillary vein is a large single, broad trunk of 10 millimeters, having two or three resistant valves and a thick wall (315µ) which contain a double muscular layer, a circular intern, external longitudinal. It extends from the edge lower of large pectoral than the top of the armpit, i.e. at the inferior edge of the clavicle. Satellite of the axillary artery, it is initially, with its lower part, located frankly at its internal dimension, separated from it by the internal branch from the median and the cubital nerve; higher, in the clavi-pectoral triangle, it is internal and former and more immediately contiguous for him; also in the preparation of the area subclavian, it is it whom one sees the first, especially if it is inflated of blood. It rests only in one weak extent of the thoracic wall, on the second dimension covered with the higher digitations with large notched. It is formed by the external meeting of both humeral veins and intern, or by the common humeral vein when both humeral veins were already amalgamated low, and continues itself directly in the subclavian vein.

This vein is normally open on the cut, character which distinguishes it from the veins of the arm and which is common for him with the subclavian and all the veins of the base of the neck. One knows several cases of dead by entry of the air in his interior, during operations practised on the axillary area. One allots this gaping to the adherence of the vein with the clavi-pectoral aponevrose or clavi-coraco-axillary. The vein does not adhere has the higher portion of this aponevrose, that which is above the small pectoral one and which is reduced to the state of fascia cribriformis; it is not fixed not at the deep layer of the sheath of small pectoral. It is below this muscle, in this triangular space which is at the base of the armpit and which is filled by the ligament hanger of Gerdy that the vein is included, and with it the remainder of the package vasculo-highly-strung person, in the major expansions of this ligament. The cavity axillary is partitioned by a fibrous blade antéropostérieure which separates it in two halves external and intern and constitutes the major part, ignored, of the ligament hanger. The vessels and the nerves cross this rather dense partition, interfered with fibrous fabric and fat lobules I found there the vein open and dilating in the direction where one operates tractions on this gangue which surrounds it. It is important to add that when one raises the clavicle (attitude of inspiration) or that the arm with right angle (attitude of operation) is drawn aside, the vein is lengthened and tended; it then forms a rigid, open in all its length, if not dilated tube. This position of the member increases the cavity of the armpit and creates there a kind of tendency to vacuum.

Branches collateral of vein axillary are same as those of artery, with this difference close that it receives vein surface, nonsatellite, vein cephalic, which emerges in its subclavian part, and that it does not receive the acromio-thoracic vein which opens in the cephalic one, moreover very close to its mouth. II thus has there lower veins scapulars or subscapulars, circumflexe former, circumflexe posterior and thoracic lower. The lower veins scapulars almost constantly present an anastomotic arcade which links them with circumflexe posterior; this large branch crosses sometimes the base of the armpit of before behind and could be wounded in an operation. Often circumflexe former and posterior ones (these bulky last), succeed has a collateral channel parallel with the vein in which it opens by its two ends: it can simulate a double vein axillary. This collecting channel passes sometimes in front of the artery. It is not rare to see the circumflexe ones opening in the deep humral veins.

The lower thoracic veins (thoracic long or mammaires external) deserve a special mention. Double satellites of the artery, furnished with many valves which look at the axillaire, they have a vast territory on the side thoracic wall (large notched, intercostal, large spaces pectoral, udder); by them the axillary cavity with negative pressure becomes a powerful center of call for the venous blood of the parts, external of the thorax. They present moreover important anastomosis, initially with six or seven higher veins intercostales, tributary of the azygos, and to which they are linked per as many perforating along the digitations large notched; then with the side branches of the epigastric veins. Therefore they constitute a great auxiliary traffic lane in the obstructions of the large venous trunks; they bring to the armpit of abdominal blood in the obstructions of the vena cava lower or of the portal vein they take along to the abdomen, in abnormal direction going down, of the blood of the upper limbs and the chest, in compressions of the vena cava higher.

One can observe a network of small veins which, born from the humeral veins with their termination, intertwine the axillary artery, higher the artery subclavian, and throw oneself in the vertebral veins. These veins, which form a collateral and additional blood way, would be according to them the true ones, satellite veins of the artery, remained rudimentary, whereas the primitive collateral vein usurped the first rank.

In addition to this network, moreover little developed, true venous trunks, of variable gauge, can accidentally skirt the axillary artery before going to throw itself in the principal vein. They are the collateral channels of the circumflexe veins, the channel which follows upon the external humeral vein and that which continues the basilica vein.

The subclavian vein

It extends from the axillary at the origin of the innominée vein, which it constitutes while being linked with the internal jugular vein; its external end corresponds to the lower edge of the clavicle, its internal end with the posterior face of the sternal end of the same bone.

Its length is the same one on the two sides; it is less than that of the artery subclavian. Its gauge is that of the small finger, approximately 12 millimeters.

Its wall is thick of 338µ with 400µ. It has a muscular tunic in most of its extent, and is deprived by it in the vicinity of its mouth. One usually finds two strong pairs valvular, one at the end interns, the outlet in the venous trunk brachiocephalic, the other with his union with the axillary.

The way of the vein subclavian is rectilinear and transverse it goes outside in inside directly, hardly projecting in top and outwards it represents the cord of the arc described by the corresponding artery, and therefore it is less long. It is thus not rigorously satellite of the artery, it is even separated by the former scalene muscle, the true veins comitantes are the small veins which intertwine in network the arteries axillary and subclavian and will be thrown in the vertebral vein.

It is in report/ratio in top and ahead, with claviculaires insertions of the sterno-mastoidian and the aponevrose cervical average, low with the muscle under-keyboard which separates it from the clavicle; in circulatory gene, it becomes visible in the known-claviculaire hollow; in bottom and have back, with the first dimension on which it rests in a gutter marked better on the posterior edge: outwards, with the tendon of the former scalene muscle which fits on the tuber of Lisfranc and separates it from the artery in inside, with the costal end of the muscle under-keyboard.

The vein subclavian is an open vein; this gaping is due to adherences that the vein, or more exactly its vascular sheath, contracts with the close aponevroses. Above the clavicle, the vein is linked by its face former to the deep face of the aponevrose cervical average, at the moment when this one will fit on the clavicle. Low, below the clavicle, it is free and slips on the first dimension but its former or higher face adheres to the thick aponevrose which is used as sheath with the under-keyboard. Moreover, from this same aponevrose of the under-keyboard, emanates large and strong fibrous expansion which embraces in half-horn the package vasculo-highly-strung person and sticks firmly to the higher face of the first coast its internal part is fixed on all the former semicircumference of the vein subclavian covered with its own sheath. The vein dilates and its natural gaping increases in all the movements which bring into play these aponevrosis, inspiratory movements, effort, rise in the arm and the clavicle.

The vein subclavian still differs from the artery at the point of sight of its collateral branches. It does not receive any of the seven branches of the artery only the intercostale higher right-hand side makes exception, and still this vein is it often lacking or can be thrown elsewhere. Scapulars higher, or scapular, and the transverse scapulars posterior or cervical, flow there only accidentally, their normal outlet is the external jugular vein; we already saw the mammaires interns, thyroid lower and vertebral opening in the innominés trunks.

On the other hand the vein subclavian receives, two surface veins, without arterial report/ratio, the external chin-strap and the former chin-strap.

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