By: Paul M. McNeill, M.D.
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3. Great Saphenous Vein
Path of the GSV
Key branches
Supporting
structures
Relationship to
nerves
Vein valve function
Pathophysiology
Anatomy impacting
treatment
4. Great Saphenous Vein
Ascends the medial
aspect of the leg and
thigh
Venous drainage of the
skin and subcutaneous
tissues
Network of branches
• Subcutaneous space
• Communicate with the
deep system
5. Great Saphenous Vein
Veins of the lower
extremity
• Return blood to the
central circulation
• Deep venous system
Primary blood return from
the leg
• Superficial System
More commonly involved
with therapy
• Perforating veins
• Communicating veins
6. Great Saphenous Vein
Veins of the lower
extremity
• Return blood to the
central circulation
• Deep venous system
Primary blood return from
the leg
• Superficial System
More commonly involved
with therapy
• Perforating veins
• Communicating veins
7. Great Saphenous Vein
Veins of the lower
extremity
• Return blood to the
central circulation
• Deep venous system
Primary blood return from
the leg
• Superficial System
More commonly involved
with therapy
• Perforating veins
• Communicating veins
8. Great Saphenous Vein
Veins of the lower
extremity
• Return blood to the
central circulation
• Deep venous system
Primary blood return from
the leg
• Superficial System
More commonly involved
with therapy
• Perforating veins
• Communicating veins
9. Superficial veins of the foot
Dorsal Venous Arch
• Lateral end of DVA
drains into SSV
• Proximal to Metatarsal
heads
• Medial end of DVA
drains into GSV
Perforating veins of
the foot
• Some drain outward to
the GSV
10. Great Saphenous Vein
At the ankle the GSV is apparent on
physical examination
The superficial presentation of the
vein allows for easy percutaneous
access
The prominence of the vein in this
location is normal
• Some patients request excision
11. Great Saphenous Vein –
Leg Branches
Duplicate saphenous
vein BK in 30%
Two major branches
below the knee
The Posterior Accessory
Vein communicates with
Posterior Tibial Vein via
perforating veins
Medial Calf Perforators
19. Anatomic Overview
Compartments of the leg
Superficial and
deep
compartments
Fascial envelope
• Defines high
pressure deep
compartment
Veins traverse the
compartments
• DV, SV, PV
20. Anatomic Overview
Calf Muscle Pump
Muscles enclosed
in fascial envelope
Muscular
contraction raises
pressure
Venous
compression
occurs
Vein valves affect
direction of flow
21. Venous Histology: Vein Valve
Thin sheets of
collagen
Smooth muscle
Endothelium
Muscle fibers at
base
Elastic fibers
22. Vein Valves
Blood propelled
by calf muscle
pump opens the
valve in one
direction
Blood moving
with gravity
closes the normal
valve
Valve Open Valve Closed
23. Saphenous Reflux
Disruption of the one way
valve system
• Primary
• Secondary
Sequential valve failure
High pressure
communicated to
superficial compartment
Tributary Varicose veins
Valvular Incompetence