The deep femoral vein (profunda femoris vein) accompanies the deep femoral artery in the thigh, draining the adductor and posterior thigh compartments through the perforating veins and the medial and lateral circumflex femoral veins. It runs in front of the artery and joins the femoral vein several centimetres below the inguinal ligament. It is a large deep vein that can be involved in thigh DVT and is the main collateral route when the femoral vein is blocked.
| Origin | Venae comitantes of the perforating arteries in the posterior thigh |
|---|---|
| Course | Ascends in front of the deep femoral artery, anterior to adductor longus, and joins the femoral vein about 8 cm below the inguinal ligament |
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The deep femoral vein is the main collateral pathway when the common femoral or superficial femoral vein is occluded by thrombus or surgical ligation. In chronic venous insufficiency and post-thrombotic syndrome, reconstruction of the common femoral vein at its junction with the deep femoral vein (common femoral vein endarterectomy or patch venoplasty) aims to restore outflow for the deep femoral territory. The deep femoral vein is identified on venous duplex ultrasound as a vessel paralleling the deep femoral artery in the proximal medial thigh.
Thrombus in the deep femoral vein as part of proximal lower extremity DVT contributes to the overall thrombus burden and is associated with a higher risk of pulmonary embolism; anticoagulation duration and thrombolysis decisions consider the extent of deep femoral involvement.
Posterior hip approaches and proximal femoral fracture fixation involve dissection adjacent to the deep femoral vein, which can be injured during medial retractor placement, particularly at the level of the lesser trochanter where the vein is at risk from plating instruments.
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