Author: Shahab Shahid, MBBS•Reviewer: Uruj Zehra, MBBS, MPhil, PhD
Last reviewed: May 25, 2023
Reading time: 8 minutes
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Main veins and tributaries of the lower extremity.
The great saphenous vein is the largest vein of the human body.It is also known as the long saphenous vein. The great saphenous veinstarts from the medial marginal vein of foot, runs superficially along the length of the lower limb, to finally empty into the femoral vein.
Just like the other veins of the lower limb, the great saphenous veinis capable of returning blood back to the heart against gravity. There is a special pumping mechanism and the presence of valves that ensure venous return. The venous system of the body is divided into a superficial and deep system. The superficial system is visible on the surface of our skin, if a tourniquet is applied. These veins are commonly used to sample blood for blood tests. Thesuperficial veins drain into deep veins (which share the same names as the arteries they run along). These deep veins return blood to the inferior and superior vena cava, and then to the right atrium of the heart.
In this article, we will discuss the anatomy and clinical relevance of the great saphenous vein.
| Origin | Medial marginal vein of foot |
| Tributaries | Small saphenous, accessory saphenous, anterior femoral cutaneous, superficial epigastric, superficial circumflex iliac, superficial external pudendal veins |
| Drains to | Femoral vein |
Contents
- Anatomy
- Location
- Course
- Femoral triangle
- Summary
- Clinical points
- Sources
+ Show all
Anatomy
Location
Great saphenous vein
Vena saphena magna
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Synonyms: Long saphenous vein
The greatsaphenous vein is a large superficial vein of the lower limb. It drains into the femoral vein, which is the medial most structure in the femoral triangle. The lateral border of the femoral triangle is formed by the medial border of sartorius, the medial border of the femoral triangle is formed by the medial border of adductor longus and theinguinal ligament forms the base of the triangle. The point at which it drains into the femoral vein is known as the saphenofemoral junction.
Course
The great saphenous vein originates from the dorsal vein of the hallux, which merges with the dorsal venous arch of the foot. The vein then runs anterior to the medial malleolus (a relatively easy area to locate the vein). The vein ascends up the medial surface of the leg, and thenruns posterior to the medial epicondyle of the femur. Itthen runs upward in the thigh and passes over the medial surface of the thigh. In the thigh it is accompanied by branches of the medial femoral cutaneous nerves, and at the knee, in the leg and the foot the vein is closely related to the saphenous artery (a branch of the descending genicular artery). The great saphenous vein then passes through an opening in thefascia lata i.e. the saphenous opening. Itcontinues as an arch to join the femoral vein within the medial region of the femoral triangle.
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Femoral triangle
Femoral triangle
Trigonum femorale
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Synonyms: Femoral trigone, Scarpa's triangle, show more...
The great saphenous vein is the medial most structure in the femoral triangle. Lateral to it,is a space that allows for expansion of the vein during increases venous return. Situated on the lateral side ofthe great saphenous vein is the femoral artery. The most lateral structure is the femoral nerve (posterior divisions of the anterior rami of spinal nerves L2-L4), which runs close to the anterior superior iliac spine, and runs beneath the inguinal ligament. There are numerous valves in this vein, that ensure blood flows in the correct direction.
There is a valve covering the saphenofemoral junction (where the saphenous vein joins the femoral vein), and separates the superficial and deep venous system.
The great saphenous vein receives smaller veins from the ankle and foot. These include the medial marginal vein (drains the sole of the foot), the small saphenous vein (it has numerous connections with its smaller counterpart in the lower region of the leg). In leg it is connected to short saphenous vein and with deep veins through perforating veins.Close to knee it receives three large tributaries, in thigh it receives many tributariesthatare posteromedial i.e accessory saphenous vein, anterolateral i.e anterior femoral cutaneous vein and peri-inguinal which are superficial epigastric, superficial circumflex iliac and superficial external pudendal veins. It also receives connecting branches from the popliteal vein via another perforator. As the vein ascends in the thigh it receives branches from the common femoral vein.
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Summary
- The great saphenous vein is a superficial vein of the lower limb
- It drains the superficial structures of the medial thigh and leg
- It drains into the common femoral vein at the saphenofemoral junction
- It receives blood from the small saphenous vein, medial marginal vein of the ankle, as well as named perforators from the veins of the thigh and knee region
- It is harvested for use in CABG procedures
- The popliteal vein connects to the great saphenous vein via a perforating vein (of Boyd)
- Another perforating vein (of Dodd) connects the common femoral vein to the great saphenous vein
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Clinical points
Coronary Artery Bypass graft (CABG)- Coronary artery disease is the biggest killer in the Western world. It is a complication of hypertension, diabetes and high cholesterol. The saphenous vein can be removed from the leg, and suturedinto the heart to bypass a blockage of the coronary arteries. This procedure is known as a heart bypass, and the patient is put on cardiopulmonary bypass during the procedure.
Thrombophlebitis- This condition is characterised by the formation of a thrombus along with inflammation in the superficial veins and involves great saphenous vein in many cases. There is a wide range of predisposing factors including prolonged immobilisation, trauma, malignancies likepancreatic cancer etc.Patients usually present with tender erythematous area overlying the superficial vein, a distended vein may be visible proximal to the thrombus. The occurrence of associated deep venous thrombosis and pulmonary embolism is variable.
Varicose veins- The great saphenous vein is a superficial vein.The deep veins (posterior tibial, anterior tibial, fibular, popliteal, femoral) are separated from the superficial veins by a series of valves. These valves ensure blood flows from the superficial system to the deep system i.e. prevents backflow. The incompetence of these valves results in varicose veins, which are engorged tortuous veins, that can be tender to the touch. Causes include genetic inheritance, pregnancy, chronic heart disease, obesityand prolonged standing.
Sources
All content published on Kenhub is reviewed by medical and anatomy experts. The information we provide is grounded on academic literature and peer-reviewed research. Kenhub does not provide medical advice. You can learn more about our content creation and review standards by reading our content quality guidelines.
References:
- Frank H.Netter MD: Atlas of Human Anatomy, 5th Edition, Elsevier Saunders.
- Chummy S.Sinnatamby: Last’s Anatomy Regional and Applied, 12th Edition, Churchill Livingstone Elsevier.
- Richard L. Drake, A. Wayne Vogl, Adam. W.M. Mitchell: Gray’s Anatomy for Students, 2nd Edition, Churchill Livingstone Elsevier.
- Knipe H, MD et al: Great saphenous vein. Radiopaedia.org (accessed 12/03/2016).
- Coronary artery bypass graft. NHS Choices (accessed 12/03/2016).
- Mayo Clinic Staff: Thrombophlebitis. Mayo Foundation for Medical Education and Research (accessed 12/03/2016).
- Litzendorf ME, Satiani B. Superficial venous thrombosis: disease progression and evolving treatment approaches. Vasc Health Risk Manag. 2011; 7: 569–575.
Illustrators:
- Great saphenous vein (Vena saphena magna) -Begoña Rodriguez
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