Great saphenous vein

Vein: Great saphenous vein
The great saphenous vein and landmarks along its course
The great saphenous vein and its tributaries at the fossa ovalis in the groin.
Latin	vena saphena magna
Gray's	p.669
Source	dorsal venous arch of the foot, and others
Drains to	femoral vein
MeSH	Saphenous+Vein

The great saphenous vein (GSV), previously also called the long saphenous vein, is a large, subcutaneous, superficial vein of the leg. It is the longest vein in the body running along the length of the leg.

The terms "safaina" (Greek, meaning "manifest," "to be clearly seen") and "el safin" (Arabic, meaning "hidden/covered") have both been claimed as the origin for the word "saphenous."^[1]

Structure

The GSV originates from where the dorsal vein of the first digit (the large toe) merges with the dorsal venous arch of the foot. After passing anterior to the medial malleolus (where it often can be visualized and palpated), it runs up the medial side of the leg. At the knee, it runs over the posterior border of the medial epicondyle of the femur bone. The great saphenous vein then courses anteriorly to lie on the anterior surface of the thigh before entering an opening in the fascia lata called the saphenous opening. It forms an arch, the saphenous arch, to join the common femoral vein in the region of the femoral triangle at the sapheno-femoral junction. ^{[citation needed]}

Tributaries

At the ankle it receives branches from the sole of the foot through the medial marginal vein; in the lower leg it anastomoses freely with the small saphenous vein, communicates by perforator veins (Cockett perforators) with the anterior and posterior tibial veins and receives many cutaneous veins; near the knee it communicates with the popliteal vein by the Boyd perforator, in the thigh it communicates with the femoral vein by perforator veins (Dodd perforator) and receives numerous tributaries; those from the medial and posterior parts of the thigh frequently unite to form a large accessory saphenous vein which joins the main vein near the sapheno-femoral junction.^[2]

Near the fossa ovalis it is joined by the superficial epigastric, superficial iliac circumflex, and superficial external pudendal veins.

The thoracoepigastric vein runs along the lateral aspect of the trunk between the superficial epigastric vein below and the lateral thoracic vein above and establishes an important communication between the femoral vein and the axillary vein.

Clinical significance

Pathology of the great saphenous vein is relatively common, but in isolation typically not life threatening.^[3]

• Varicose veins: The great saphenous vein, like other superficial veins, can become varicose; swollen, twisted and lengthened, and generally considered to be unsightly. Varicose veins are not life threatening and various treatment options are available.

• Thrombophlebitis: The GSV can thrombose. This type of phlebitis of the GSV is usually not life threatening in isolation; however, if the blood clot is located near the sapheno-femoral junction or near a perforator vein, a clot fragment can migrate to the deep venous system and to the pulmonary circulation. Also it can be associated with, or progress to a deep vein thrombosis which must be treated promptly. So a GSV thrombosis is investigated by ultrasonography to detect if these complications are present.^[3]

Use in cardiovascular procedures

The vein is often removed by vascular surgeons and used for autotransplantation in coronary artery bypass operations, when arterial grafts are not available or many grafts are required, such as in a triple bypass or quadruple bypass.

The great saphenous vein is the conduit of choice for vascular surgeons,^[4][5] when available, for doing peripheral arterial bypass operations [ see vascular bypass ] because it has superior long-term patency compared to synthetic grafts (PTFE, PETE (Dacron)), human umbilical vein grafts or biosynthetic grafts [Omniflow]. Often, it is used in situ (in place), after tying off smaller tributaries and stripping the valves with a device called LeMaitre's valvulotome.

The saphenous nerve is a branch of the femoral nerve that runs with the great saphenous vein and is often damaged in surgeries that make use of the similarly named vein.

Use in emergency medicine

When emergency resuscitation with fluids is necessary, and standard intravenous access cannot be achieved due to venous collapse, saphenous vein cutdown may be necessary.

See also

This article uses anatomical terminology; for an overview, see anatomical terminology.

• Coronary artery bypass grafting (CABG)
• Varicose veins
• Saphena varix

Additional Images

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  Superficial veins oflower limbSuperficial dissection.Anterior view.

• 

  GREAT SAPHENOUS VEINDeep dissection.Anterior view.

• 

  Illustration depicting veins of the leg including great saphenous vein (anterior view).

References

External links

• Gray's s157 - "The arteries of the lower extremity" - Gray's Anatomy.
• Gray's s173 - "The veins of the lower extremity, abdomen, and pelvis" - Gray's Anatomy.
• Great saphenous vein - Stedman's medical dictionary.
• 11:02-0102 at the SUNY Downstate Medical Center
• 11:03-0105 at the SUNY Downstate Medical Center
• Mnemonic at medicalmnemonics.com 278