Which vein connects to the three main perforating veins of the distal calf?

The posterior arch vein is the correct answer because it plays a crucial role in the venous drainage of the calf, particularly in relation to the perforating veins. These perforating veins, also known as communicating veins, connect the superficial venous system with the deep venous system in the lower leg. Specifically, the three main perforating veins of the distal calf—commonly referred to as the Boyd’s perforators—connect directly to the posterior arch vein, which then drains into deeper structures.

In contrast, the great saphenous vein primarily runs along the inner side of the leg and thigh and is connected to other perforating veins, but not directly to the specific three main perforators of the distal calf. The small saphenous vein, on the other hand, is located on the back of the calf and typically connects to different perforating veins in the region. The femoral vein does not connect with the perforating veins in the distal calf, as it is located higher in the leg and serves to drain deep structures of the thigh rather than the calf.

Understanding the role of the posterior arch vein in relation to the perforating veins is critical for appreciating venous return mechanisms in the leg and the underlying vascular anatomy.