Anatomy Atlas

Great saphenous vein

Vena saphena magna
Also: Long saphenous vein · GSV
VeinHigh-yielddraftCardio

The longest vein in the body, running superficially from the front of the medial malleolus to the groin. It is the usual source of varicose veins and a common graft for coronary bypass.

Core anatomy

Location

Superficial fascia of the medial leg and thigh.

Formation

From the medial end of the dorsal venous arch of the foot.

Course

Passes anterior to the medial malleolus (reliably, for cutdown access), ascends along the medial leg with the saphenous nerve, passes a hand's breadth behind the medial border of the patella, up the medial thigh, and through the saphenous opening in the fascia lata to join the femoral vein about 3–4 cm below and lateral to the pubic tubercle (the saphenofemoral junction).

Tributaries
  • Superficial veins of the medial leg and thigh, including accessory saphenous veins
  • Near the junction: superficial epigastric, superficial circumflex iliac and superficial external pudendal veins
  • Communications with the small saphenous vein and, through perforating veins with one-way valves, with the deep veins
Drains into

Femoral vein at the saphenofemoral junction (see deep veins of the lower limb).

Relations

The saphenous nerve runs with it below the knee (injury causes medial leg numbness). The small saphenous vein runs up the back of the calf to the popliteal vein.

Found in

Mentioned in

Generated automatically from links in other entries.

Femoral triangle (right, anterior view)The femoral triangle of the right thigh, with lateral on the left. Its base is the inguinal ligament, from the anterior superior iliac spine to the pubic tubercle; its lateral border is sartorius and its medial border adductor longus, which meet at the apex, where the adductor canal begins. The floor is iliopsoas laterally and pectineus medially. From lateral to medial lie the femoral nerve outside the femoral sheath, then inside the sheath the femoral artery, the femoral vein and the femoral canal, with the deep inguinal lymph nodes most medially (NAVEL). The great saphenous vein joins the femoral vein through the saphenous opening, below and lateral to the pubic tubercle. The deep femoral artery leaves the femoral artery a few centimetres below the ligament and runs posteriorly.ASISInguinal ligamentFemoral nerveDeep femoral arteryIliopsoas (floor)SartoriusApex → adductor canalPubic tubercleFemoral arteryFemoral veinFemoral canal (ring)Deep inguinal nodesSaphenofemoral junctionPectineus (floor)Adductor longusGreat saphenous veinLateral ←→ MedialNAVEL, lateral → medialDashed outline = femoral sheath

Swipe sideways to see the whole diagram →

Femoral triangle (right, anterior view). Lateral on your left. The base is the inguinal ligament, the borders are sartorius (lateral) and adductor longus (medial), and the floor is iliopsoas and pectineus. Lateral to medial: Nerve (outside the femoral sheath), Artery, Vein, Empty space (femoral canal), Lymphatics. The pulse is felt just below the mid-inguinal point, with the vein just medial to it; a femoral hernia comes through the femoral canal.
Original schematic, created for this atlas.
Superficial epigastric, circumflex iliac and external pudendal veins joining the great saphenous vein at its junction with the femoral vein
Tributaries at the saphenofemoral junction.
Henry Vandyke Carter, Gray's Anatomy of the Human Body, 20th ed. (1918), Fig. 584. Source · Public domain (Public domain in the US: published before January 1, 1931 (per Wikimedia Commons))
Dissection of the femoral triangle showing the femoral nerve, artery and vein, sartorius, adductor longus and the great saphenous vein
The great saphenous vein joining the femoral vein in the femoral triangle.
Henry Vandyke Carter, Gray's Anatomy of the Human Body, 20th ed. (1918), Fig. 549. Source · Public domain (Public domain in the US: published before January 1, 1931 (per Wikimedia Commons))

Clinical correlations

Varicose veins and chronic venous insufficiency PANCE

Mechanism / lesion

Valve incompetence (often at the saphenofemoral junction) with reflux and venous hypertension; risk factors — age, female sex, pregnancy, obesity, prolonged standing, prior DVT.

Classic presentation

Dilated tortuous veins, aching and heaviness worse at the end of the day, ankle edema; advanced disease causes hyperpigmentation, lipodermatosclerosis and venous ulcers above the medial malleolus. Treat with compression and leg elevation; endovenous ablation or sclerotherapy for symptomatic reflux.

Superficial thrombophlebitis PANCE

Mechanism / lesion

Thrombosis of a superficial vein (varicosities, IV cannulas, pregnancy, malignancy).

Classic presentation

A tender, red, palpable cord. Ultrasound because about a quarter have associated DVT; thrombus within about 3 cm of the saphenofemoral junction (or long segments) is treated with anticoagulation.

Saphenous vein graft

Mechanism / lesion

Harvested for coronary artery bypass grafting and peripheral bypass (reversed so its valves don't block flow).

Classic presentation

Donor-leg complications include wound infection and saphenous nerve numbness.

High-yield PANCE pearls

  • Venous ulcer: above the medial malleolus, shallow, irregular, with hyperpigmentation → compression.
  • Arterial ulcer: distal (toes, lateral malleolus), punched out, painful.
  • Superficial thrombophlebitis → ultrasound (DVT coexists); anticoagulate if near the saphenofemoral junction.
  • GSV lies anterior to the medial malleolus.

Imaging anatomy

Ultrasound

Venous duplex ultrasound with reflux testing (standing) maps incompetent valves and excludes DVT.

Key views & landmarks
  • Venous reflux duplex ultrasound (standing)

Physical exam

Surface landmarks

Visible or palpable just in front of the medial malleolus; the saphenofemoral junction lies about 3–4 cm inferolateral to the pubic tubercle.

Palpation

Palpate for cords, tenderness and a cough impulse at the saphenofemoral junction (reflux).

Strength / function testing

Inspect the standing patient for varicosities, edema, skin changes and ulcers; compare with arterial pulses before compression therapy (check ABI).

Trendelenburg (Brodie–Trendelenburg) test

Technique

Elevate the leg to empty the veins, apply a tourniquet around the upper thigh (or press on the saphenofemoral junction), then have the patient stand.

Positive test

Rapid filling of varicosities from above when the tourniquet is released (saphenofemoral incompetence); filling with the tourniquet in place implies incompetent perforators below.

Significance

Localizes valvular incompetence (largely replaced by duplex ultrasound).

Self-quiz

Q1.

A 62-year-old woman who works as a cashier has a shallow, irregular ulcer above her left medial malleolus with surrounding brown pigmentation and ankle edema. Pedal pulses are normal. What is the first-line treatment?

Show answer

B

This is a venous stasis ulcer from chronic venous insufficiency. Compression (after confirming adequate arterial flow) and elevation are the cornerstone; ablation of refluxing veins reduces recurrence.

Q2.

Where does the great saphenous vein end?

Show answer

B

The great saphenous vein passes through the saphenous opening in the fascia lata to join the femoral vein in the femoral triangle. The small saphenous vein drains to the popliteal vein.

Q3.

Where is the great saphenous vein reliably found at the ankle, for example for a venous cutdown?

Show answer

C

The great saphenous vein begins at the medial end of the dorsal venous arch and passes anterior to the medial malleolus, a reliable site for cutdown. The small saphenous vein passes behind the lateral malleolus.

Q4.

Which feature suggests an arterial rather than a venous leg ulcer?

Show answer

D

Arterial ulcers are distal (toes, lateral malleolus), punched out and painful, with poor pulses. Venous ulcers are shallow and irregular, above the medial malleolus, with hyperpigmentation and edema, and are treated with compression.

Q5.

A patient has a tender, red, palpable cord along the great saphenous vein in the thigh. What is the most appropriate next step?

Show answer

B

Superficial thrombophlebitis can coexist with DVT (in about a quarter of cases), so duplex ultrasound is needed. Thrombus close to the saphenofemoral junction or long segments are treated with anticoagulation.

Flashcards

See also