The normal flow is directed from distal to proximal and from superficial to deep. In addition, veins have valves that play an important role in preventing reflux of the venous flow ( Fig. The compressibility of veins and pulsation of the arteries can be a way to discriminate them in US. In contrast to arteries, veins have a weaker muscular layer with less elastic walls, and therefore completely collapse when the vein is compressed by the transducer ( Fig. General Considerations for the US Examination of Veins This article reviews the anatomy of the deep, superficial, and perforating veins in the lower extremities for US and provides practical tips for approaching each vein to evaluate venous disease of the lower extremities. These groups are closely related to one another. The veins that lie beneath the muscular fascia and drain the lower extremity muscles are the deep veins, those that are above the muscular fascia and drain the cutaneous microcirculation are the superficial veins, and those that penetrate the muscular fascia and connect the superficial and deep veins are the perforating veins ( Fig. The venous system of the lower extremities is classified into three groups according to the relationship to the muscular fascia that surrounds the calf and leg muscles. An understanding of the lower extremity venous system is important for diagnosing and determining the pathophysiology of venous disease. The examiner should be familiar with the normal venous anatomy of the lower extremities, which is somewhat different from the corresponding arterial anatomy. Ultrasonography (US) is the most useful and widely used modality for evaluating venous diseases of the lower extremities.
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