White J V, Katz M L, Cisek P, Kreithen J
Department of Surgery, Temple University, Philadelphia, PA 19140, USA.
J Vasc Surg. 1996 Nov;24(5):819-24. doi: 10.1016/s0741-5214(96)70018-6.
Mechanisms of venous outflow from the leg and foot have not been clearly defined. The purpose of this study was to evaluate the anatomy and physiologic mechanism of the plantar venous plexus and its impact on venous drainage from the tibial veins.
Fifty phlebograms that contained complete foot and calf films were reviewed. On lateral films, the number of veins in the plantar venous plexus and its tibial outflow tract were counted. The length and diameter of the longest vein in the plantar venous system and the length of the foot arch were measured. The ratio of the length of the plantar venous plexus to the arch length was calculated. The presence or absence of valves within the plexus was recorded. Plantar venous plexus outflow was evaluated by an duplex ultrasonographic scan of the posterior tibial, anterior tibial, and peroneal veins during intermittent external pneumatic compression of the plantar surface of the foot.
The plantar venous plexus was composed of one to four large veins (mean, 2.7 veins) within the plantar aspect of the foot. The diameter of these veins was 4.0 +/- 1.2 mm. The veins coursed diagonally from a lateral position in the forefoot to a medial position at the level of the ankle, spanning 75% of the foot arch. Prominent valves were recognized within the plantar veins in 22 of 50 patients. The plexus coalesced into an outflow tract of one to four veins (mean, 2.5 veins) that flowed exclusively into the posterior tibial venous system. Small accessory veins that drained the plantar surface of the forefoot flowed into either the posterior tibial or peroneal veins. This pattern of selective drainage of the plantar venous plexus was confirmed by duplex imaging. Mechanical compression of the plantar venous plexus produced a mean peak velocity in the posterior tibial veins of 123 +/- 71 cm/sec, in the anterior tibial veins of 24 +/- 14 cm/sec, and in the peroneal veins of 29 +/- 26 cm/sec.
The plantar venous plexus is composed of multiple large-diameter veins that span the arch of the foot. Compression of the plantar venous plexus, such as that which occurs during ambulation, is capable of significantly increasing flow through the posterior tibial venous system into the popliteal vein. Its function may be integral to venous outflow from the calf and priming of the more proximal calf muscle pump.
小腿和足部静脉流出的机制尚未明确界定。本研究的目的是评估足底静脉丛的解剖结构和生理机制及其对胫静脉血液引流的影响。
回顾了50份包含完整足部和小腿X线静脉造影图像。在侧位片上，计数足底静脉丛及其胫静脉流出道中的静脉数量。测量足底静脉系统中最长静脉的长度和直径以及足弓的长度。计算足底静脉丛长度与足弓长度的比值。记录丛内瓣膜的有无。通过对足部足底进行间歇性外部气动压迫时对胫后静脉、胫前静脉和腓静脉进行双功超声扫描来评估足底静脉丛的流出情况。
足底静脉丛由足部足底的1至4条大静脉（平均2.7条静脉）组成。这些静脉的直径为4.0±1.2毫米。静脉从前足的外侧斜向走行至踝关节水平的内侧，跨越足弓的75%。50例患者中有22例在足底静脉内发现明显瓣膜。静脉丛汇聚成1至4条静脉（平均2.5条静脉）的流出道，这些静脉仅流入胫后静脉系统。引流前足足底的小副静脉流入胫后静脉或腓静脉。双功成像证实了足底静脉丛的这种选择性引流模式。对足底静脉丛进行机械压迫时，胫后静脉的平均峰值速度为123±71厘米/秒，胫前静脉为24±14厘米/秒，腓静脉为29±26厘米/秒。
足底静脉丛由多条横跨足弓的大直径静脉组成。足底静脉丛的压迫，如在行走过程中发生的压迫，能够显著增加通过胫后静脉系统进入腘静脉的血流量。其功能可能对于小腿的静脉流出以及更近端小腿肌肉泵的启动不可或缺。
