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Anatomy · Heart & blood vessels

Great saphenous vein

Longest vein in the body

Lower limb · superficial venous system

The longest vein in the body. It begins at the medial end of the dorsal venous arch of the foot, passes in front of the medial malleolus, ascends along the medial side of the leg and thigh, and drains into the femoral vein at the saphenofemoral junction, through the saphenous opening about 3–4 cm below and lateral to the pubic tubercle. It is a superficial vein, prone to varicosities, and the classic graft for coronary bypass.

How to spot them

  • ▸Passes in front of the medial malleolus, a landmark for emergency venous cut-down
  • ▸Runs up the medial side of the leg, about a hand's breadth behind the medial border of the patella, and up the medial thigh
  • ▸Accompanied in the leg by the saphenous nerve, which can be damaged in stripping
  • ▸Ends by piercing the cribriform fascia at the saphenous opening to enter the femoral vein

What to know

The longest vein in the body, running from the medial side of the foot to the groin

Great saphenous vein.

Passes in front of the medial malleolus, where a cut-down provides emergency access to the circulation

Great saphenous vein — the ankle cut-down.

Drains into the femoral vein at the saphenofemoral junction, through the saphenous opening in the fascia lata

Great saphenous vein — about 3–4 cm below and lateral to the pubic tubercle.

The vein most often taken for coronary artery bypass grafts, usually reversed so its valves do not obstruct flow

Great saphenous vein — harvested from the leg.

A nerve that runs with it below the knee can be injured during removal of varicose veins

Great saphenous vein — the saphenous nerve.

Incompetent valves in this superficial vein cause dilated, tortuous varicosities on the medial leg and thigh

Great saphenous vein — varicose veins.

It has 10–20 valves, and perforating veins connect it to the deep veins through the muscular fascia

Great saphenous vein — its valves and perforators.

Key ideas

  • Superficial veins lie in the subcutaneous fat, outside the deep fascia; they connect to the deep veins via perforators, whose valves let blood flow only inwards.
  • Failure of valves in the vein or its perforators allows high pressure to be transmitted to the skin, causing varicosities, oedema and ulceration.

Quick-fire facts

  • •Starts at the medial end of the dorsal venous arch of the foot.
  • •Passes anterior to the medial malleolus, then posterior to the medial condyle of the femur and tibia (about a hand's breadth behind the medial border of the patella).
  • •Ends in the femoral vein at the saphenofemoral junction, 3–4 cm below and lateral to the pubic tubercle.
  • •Has around 10–20 valves along its length.
  • •The small saphenous vein is the other main superficial vein, on the back of the calf, draining to the popliteal vein.
  • •The saphenous nerve, a branch of the femoral nerve, accompanies it below the knee.
  • •Coronary artery bypass surgery, first performed with a saphenous vein graft by René Favaloro at the Cleveland Clinic in 1967, remains a common use.
  • •Tributaries at the groin include the superficial epigastric, superficial circumflex iliac and external pudendal veins.

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Sources