Superior epigastric veins

At a glance

English

Superior epigastric veins

Latin (TA2)

Venae epigastricae superiores

System

Vein

Region

Trunk

Side

Paired, left and right

About the superior epigastric veins

The superior epigastric veins drain the upper part of the front abdominal wall and a small part of the diaphragm. They are usually two companion veins on each side, wrapped around the superior epigastric artery, and they run on the deep surface of rectus abdominis within the rectus sheath, behind the muscle and in front of the posterior layer of the sheath.

Their tributaries come from rectus abdominis, from the surrounding sheath and from the skin and fat of the upper abdomen, reaching them through perforating veins. Small veins from the anterior part of the diaphragm and from the falciform ligament may also drain into them. Around the umbilicus, inside the rectus sheath, their lower branches meet branches of the inferior epigastric veins coming up from below. This junction creates a continuous venous path down the front of the trunk.

Above, the veins leave the rectus sheath and pass between the sternal and costal attachments of the diaphragm, behind the seventh costal cartilage. There they continue upwards as the internal thoracic veins, which ascend behind the costal cartilages to end in the brachiocephalic veins.

The connection between the superior and inferior epigastric veins is important when one of the venae cavae is obstructed. If the inferior vena cava is blocked, blood from the legs and pelvis can reach the superior vena cava by flowing up the inferior epigastric veins, into the superior epigastric and internal thoracic veins. The reverse route is used when the superior vena cava is blocked. In such cases the enlarged veins may become visible on the abdominal wall. The veins and their artery also determine the blood supply to muscle and skin flaps raised from the upper rectus, and they can be damaged by surgical incisions or ports placed through the upper rectus sheath, causing a haematoma in the sheath.

Course and drainage

Begins at

Formed within the upper rectus sheath from veins of rectus abdominis and the upper abdominal wall, connecting at the umbilicus with the inferior epigastric veins.

Drains into

Pass up between the sternal and costal parts of the diaphragm to continue as the internal thoracic veins.

Drains

Drain the upper anterior abdominal wall, including rectus abdominis, and part of the anterior diaphragm; they link the internal thoracic and external iliac venous territories.