Great saphenous vein

The great saphenous vein (GSV) forms part of thesuperficial venous system of the lower limb. 

Terminology

The great saphenous vein is the preferred term over other variants such as long saphenous vein (LSV), greater saphenous vein or internal saphenous vein ⁵.

Gross anatomy

Origin and course

The great saphenous vein lies within the subcutaneous tissues of the leg in the thigh in the saphenous compartment, which is bounded posteriorly by the deep fascia and superficially by the saphenous fascia ³. 

The great saphenous vein forms on the dorsum of the foot as the continuation of the medial marginal vein of the foot. It then passes anteriorly to the medial malleolus to ascend at first medial to and then posterior to the medial aspect of the tibia.

The great saphenous vein then winds its way around the medial aspect of the knee and continues upwards in the medial aspect of the thigh to pierce the saphenous hiatus of the deep fascia of the thigh, 1-3 cm distal to the inguinal ligament, to drain into the femoral vein at the saphenofemoral junction (SFJ) in the femoral triangle. 

There is a constant (~99%) presence of a venous valve 1-2 mm distal to the saphenofemoral junction ³.

Tributaries

• small saphenous vein (SSV): communicating branches in the region of the popliteal fossa
• lateral accessory vein
• superficial epigastric vein
• superficial circumflex iliac vein
• superficial external iliac vein
• superficial external pudendal vein
• deep external iliac vein
• anterior accessory saphenous vein

It communicates throughout its entire length with the deep venous system via perforating veins ^1,2.

Relations

• below the knee, the branches of the saphenous nerve are located posteriorly and anteriorly ^1,3
• above the knee the saphenous nerve is not closely related (i.e. is not within the saphenous compartment) ³

Variant anatomy

• segmental hypoplasia ³
• duplication: only in the thigh; ~1% of the population ³
  • duplicated great saphenous vein lies within the saphenous compartment
• accessory saphenous veins: ascend with the SSV or GSV
  • lie outside the saphenous compartment ³

Radiographic features

Ultrasound

• appears as "Egyptian eye" or "sonographic eye sign" ³
  • upper eyelid: echogenic linear saphenous fascia
  • eye: great saphenous vein
  • lower eyelid: echogenic linear deep fascia