Superior epigastric veins

Medically Reviewed by Anatomy Team

Last updated on January 23, 2025

The superior epigastric veins are part of the venous system that drains blood from the anterior abdominal wall. These veins are located in the lower portion of the thorax and upper abdomen. They run along with the superior epigastric arteries, beginning at the level of the diaphragm. The superior epigastric veins are the continuation of the internal thoracic veins and travel downward through the rectus sheath, lying posterior to the rectus abdominis muscle. These veins eventually drain into the internal thoracic vein, which then empties into the brachiocephalic vein, contributing to venous return to the heart.

Location

The superior epigastric veins are located in the anterior abdominal wall and run vertically from the thoracic region to the upper part of the abdomen. These veins are positioned within the rectus sheath, deep to the rectus abdominis muscle, and descend from the thoracic cavity into the abdominal region. They are paired with the superior epigastric arteries, which run along a similar course.

Anatomy

Origin

The superior epigastric veins originate as a continuation of the internal thoracic veins at the level of the sixth intercostal space. The internal thoracic veins, which accompany the internal thoracic arteries, collect venous blood from the thoracic wall and diaphragm. As they descend into the abdominal wall, they become the superior epigastric veins.

Course

The superior epigastric veins run inferiorly along the posterior surface of the rectus abdominis muscle, within the rectus sheath. This course follows the same path as the superior epigastric arteries, which provide blood supply to the same region. The veins pass from the thoracic cavity into the abdominal cavity by piercing through the diaphragm near the midline.

As they descend, the superior epigastric veins drain blood from the upper portion of the anterior abdominal wall. They eventually converge with smaller tributaries along their course before terminating into the internal thoracic veins.

Relations to Neighboring Structures

Rectus Abdominis Muscle: The superior epigastric veins run deep to the rectus abdominis muscle, within the fibrous sheath that encloses this muscle. This positioning places them in close proximity to the superior epigastric arteries, which supply blood to the same region.
Diaphragm: These veins pass through the diaphragm as they descend from the thoracic cavity into the abdominal cavity.^[6] The diaphragm is a crucial anatomical landmark for their transition from the thoracic to the abdominal region.
Internal Thoracic Veins: The superior epigastric veins are continuous with the internal thoracic veins, which lie higher up in the thoracic cavity and drain the anterior chest wall and upper diaphragm.
Inferior Epigastric Veins: As the superior epigastric veins descend, they anastomose with the inferior epigastric veins, which ascend from the lower abdominal wall. This venous anastomosis forms an important connection between the thoracic and abdominal venous systems.

Tributaries

The superior epigastric veins receive several small tributaries along their course, which drain blood from the upper portions of the anterior abdominal wall. These tributaries are mainly small veins that accompany the branches of the superior epigastric artery, and they assist in collecting venous blood from the muscles and skin of the upper abdomen.

Termination

The superior epigastric veins terminate by draining into the internal thoracic veins, which eventually empty into the brachiocephalic veins. The brachiocephalic veins, in turn, contribute to the formation of the superior vena cava, which returns blood to the right atrium of the heart. This pathway allows for the venous return of blood from the anterior abdominal wall to the systemic circulation.

Variations

The anatomy of the superior epigastric veins is generally consistent, but variations can occur in the exact size and number of tributaries. The extent of anastomosis with the inferior epigastric veins can also vary, with some individuals having more prominent venous connections between these two systems.^[5] These variations typically do not affect the overall function of the veins but can be relevant in surgical or diagnostic procedures.

Function

Venous Drainage of the Anterior Abdominal Wall

The primary function of the superior epigastric veins is to drain deoxygenated blood from the upper part of the anterior abdominal wall.^[2] This area includes the skin, subcutaneous tissues, and muscles of the upper abdomen, particularly the rectus abdominis muscle. These veins collect blood from smaller venous tributaries that emerge from the muscular and connective tissues, ensuring proper venous return from the upper abdominal region.

Connection with the Thoracic Venous System

The superior epigastric veins form a key connection between the venous systems of the thorax and abdomen. They drain blood from the anterior abdominal wall into the internal thoracic veins, which eventually empty into the brachiocephalic veins and, finally, the superior vena cava. This connection ensures that blood from the upper abdomen is efficiently transported back to the heart. By linking the thoracic and abdominal venous systems, the superior epigastric veins support overall venous return from the upper body.

Maintenance of Venous Pressure Balance in the Abdominal Wall

The superior epigastric veins help maintain balanced venous pressure in the upper abdominal wall.^[1] By providing a clear route for blood to flow from the anterior abdominal tissues back to the heart, these veins prevent blood from pooling in the abdominal muscles or skin, reducing the risk of venous congestion or swelling. This is especially important during activities that increase intra-abdominal pressure, such as heavy lifting or physical exertion, when increased venous return is required to accommodate higher blood flow.

Anastomosis with Inferior Epigastric Veins

The superior epigastric veins create an important anastomosis with the inferior epigastric veins, which drain the lower portion of the anterior abdominal wall. This venous connection is essential for collateral circulation between the upper and lower abdominal regions, providing alternative pathways for blood flow if one part of the venous system becomes obstructed.^[7] This anastomosis helps maintain venous drainage even in cases of vascular occlusion or compression, ensuring that blood can still be returned to the heart via alternate routes.

Assistance in Thermoregulation of the Abdominal Wall

By draining blood from the upper abdominal wall, the superior epigastric veins play a role in thermoregulation. Blood flowing through the abdominal muscles and skin carries heat, which can be dissipated as the blood is returned to the central circulation. The superior epigastric veins assist in this process by efficiently removing warm blood from the abdominal region, helping to regulate the temperature of the anterior abdominal wall.

Support for Respiratory Movements

The superior epigastric veins, along with the superior epigastric arteries, pass through the diaphragm, which plays a critical role in respiration. During breathing, particularly during deep inspiration, the diaphragm moves downward, increasing intra-abdominal pressure and compressing the veins.^[5] The superior epigastric veins are structured to withstand these changes in pressure, ensuring that venous return from the abdominal wall continues even during respiratory movements. By facilitating blood drainage from the diaphragm and abdominal wall during respiration, these veins support efficient breathing mechanics.

Role in Post-Surgical Recovery

In the context of abdominal surgeries, particularly procedures that involve the rectus abdominis muscle or anterior abdominal wall, the superior epigastric veins are essential for post-operative recovery. By maintaining effective venous drainage, they prevent the accumulation of blood or fluid (e.g., hematomas or seromas) in the surgical site, which can impair healing. Proper drainage through the superior epigastric veins reduces the risk of complications and supports faster recovery after surgery.

Prevention of Venous Congestion

The superior epigastric veins play an important role in preventing venous congestion in the upper abdominal wall. If venous return from the anterior abdominal wall were compromised, blood could pool in the tissues, leading to swelling, pain, or impaired muscle function. By providing an efficient route for blood to return to the heart, the superior epigastric veins help avoid these complications, ensuring that the abdominal wall remains healthy and functional.

Clinical Significance

The superior epigastric veins hold clinical significance due to their role in draining the anterior abdominal wall and their connections with the thoracic venous system.^[1] They are important in abdominal surgeries, particularly procedures involving the rectus abdominis muscle or anterior abdominal wall, as damage to these veins can lead to excessive bleeding or hematoma formation. Their anastomosis with the inferior epigastric veins also provides an important collateral circulation route, which becomes crucial if the main venous pathways are obstructed.

The superior epigastric veins are also considered during diagnostic imaging and evaluations for conditions like varicosities or venous insufficiency in the abdominal region.^[3] Additionally, they can be involved in conditions affecting venous return from the lower limbs, as their anastomoses may be utilized as collateral pathways in cases of venous obstruction.

References

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Hollinshead WH. (1982). Anatomy for Surgeons: Volume 2, The Thorax and Abdomen (3rd ed.). Harper & Row. ISBN 978-0-397-51049-0.
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