Great saphenous vein and small saphenous veins are veins of the lower limb.
The great saphenous vein is the longest vein in the body that originates near medial malleolus and goes up to the level of groin skin crease. blood from the foot, leg, and thigh to the deep femoral vein at the femoral triangle. It is referred to as the greater or long saphenous vein. The standard accepted term now is great saphenous vein.
The other sapahenous vein is called small or short saphenous vein or lesser saphenous vein. It begins at the lateral aspect of the ankle and runs up the posterolateral lower leg to join the popliteal vein in the popliteal fossa.
Great Saphenous Vein
Great Saphenous vein originates at the ankle as a continuation of the medial marginal vein of the foot and ends at the femoral vein within the femoral triangle.
The great saphenous vein lies within the subcutaneous tissues of the leg in the thigh in the saphenous compartment. This compartment is bounded posteriorly by the deep fascia and superficially by the saphenous fascia.
The great saphenous vein forms on the dorsum of the foot as the continuation of the medial marginal vein of the foot. At the ankle, it crosses 1 cm anterior to the medial malleolus and winds its way around the medial aspect of the knee and continues upwards in the medial aspect of the thigh to pierce the saphenous opening of the deep fascia of the thigh, 1-3 cm distal to the inguinal ligament.
It drains into the femoral vein at the saphenofemoral junction in the femoral triangle.
A valve is present in about 99 percent of peopl e 1-2 mm distal to the sapheno-femoral junction [before the vein drains into the femoral vein.]
It communicates throughout its entire length with the deep venous system via perforating veins
Below the knee, the branches of the saphenous nerve are located posteriorly and anteriorly to the great saphneous vein. Above the knee, the saphenous nerve is not closely related.
Tributaries of Great Saphenous Vein
- Small saphenous vein via communicating branches
- Lateral accessory vein
- Superficial epigastric vein
- Superficial circumflex iliac vein
- Superficial external iliac vein
- Superficial external pudendal vein
- Deep external iliac vein
- In the leg, it anastomoses with the small saphenous vein and receives many cutaneous veins
- It communicates with the anterior and posterior tibial veins [via Cockett perforators] and receives many cutaneous veins.
- With the popliteal vein by the Boyd perforator [near knee]
- In thigh, with the femoral vein by perforator veins (Dodd perforator).
- Receives numerous tributaries in the thigh
- Medial and posterior veins of the thigh frequently unite to form a large accessory saphenous vein which joins the main vein near the sapheno-femoral junction.
- Near the fossa ovalis at the upper end of the thigh, it is joined by
- The superficial epigastric
- Superficial circumflex iliac vein
- 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. It establishes an important communication between the femoral vein and the axillary vein.
- Segmental hypoplasia
- Duplication [in the thigh, in about 1% of the population]
- Accessory saphenous vein
Accessory saphenous vein lies outside the saphenous compartment but in case of duplication, the duplicated vein lies inside the compartment only.
Clinical Significance of Great Saphenous Vein
Appears as “Egyptian eye” or “sonographic eye sign”
- Upper eyelid – Echogenic linear saphenous fascia
- Eye – Great saphenous vein
- Lower eyelid – Echogenic linear deep fascia
The great saphenous vein, like other superficial veins, can become varicose or get inflamed [thrombophelbitis].
Use of Vein
- As graft in coronary artery bypass surgery
- Saphenous vein cutdown for emergency venous access
Small Saphenous Vein
The small saphenous vein (also short saphenous vein), is a relatively large superficial vein of the posterior leg.
Small saphenous vein originates where the dorsal vein from the fifth digit (smallest toe) merges with the dorsal venous arch of the foot, which attaches to the great saphenous vein small saphenous vein).
It courses around the lateral aspect of the foot, inferior and posterior to the lateral malleolus and runs along the posterior aspect of the leg along with the sural nerve. It passes between the heads of the gastrocnemius muscle.
The nerve may have variable draining points but often it drains into the popliteal vein, at or above the level of the knee joint.
- Communicating branches with the great saphenous vein
- Cutaneous venous tributaries
It communicates with the deep venous system via numerous perforating veins.
- May join the common gastrocnemius vein before draining in the popliteal vein.
- Extends into thigh as the vein of Giacomini, courses between biceps femoris and semimembranosus muscles and drains into superficial including Great saphenous], perforating or deep veins.