The Anatomy of the Great Saphenous Vein

Running from the top of the foot (dorsum) and up the inner sides of the leg, the great saphenous vein is the body’s longest vein. Sometimes called the long saphenous vein, it arises from the medial marginal vein of the foot. It terminates as it drains into the femoral vein on the inner (medial) side of the femoral triangle of the pelvis.

The great saphenous vein’s primary task is to drain deoxygenated blood from the foot, as well as superficial parts of the leg and knee (closer to the surface). This is taken back to the heart and lungs, where oxygen and nutrients are restored for delivery to the rest of the body.

Since the great saphenous vein is close to the skin’s surface, it’s sometimes used for sampling blood for testing. Sections of this vein may be harvested for use in coronary artery bypass graft (CABG) surgery for heart disease.

The great saphenous vein can be impacted by thrombophlebitis (blood clotting) or become varicose (in which blood pools in the vein).

Anatomy

Structure

Like all venous vessels, the walls of the great saphenous vein are composed of three layers:

• Tunica intima: The innermost layer is composed of epithelium, a thin layer of cells, and other connective tissues to form a protective coating.
• Tunica media: This is a middle, smooth muscle layer associated with influencing blood pressure, blood flow, and overall diameter.
• Tunica extrema: This outer layer is composed of elastic, collagenous fibers. It connects to fibers in surrounding tissues and muscles for support.

Notably, since this vein is tasked with bringing blood back to the heart, it has numerous venous valves, which prevent backflow and help promote circulation. These are especially important for ensuring that blood doesn’t flow back into deeper veins in the body.   

Location

The course of the great saphenous vein takes it from the foot to the thigh. It’s a superficial vein, meaning it runs closer to the surface of the skin. Its path can be subdivided into three portions:

• In the foot, the great saphenous vein emerges from the medial marginal vein, which arises at the confluence of the dorsal vein of the big toe (clinically called the hallux) and the dorsal venous arch of the top of the foot. It runs along a part of the leg called the saphenous compartment.
• Along its upward course, it runs first medially (along the inner side) and then in front of the tibia, one of the two major bones of the lower leg. Around the knee, the great saphenous vein runs behind the medial epicondyle of the femur, a protrusion on the inner side of the leg. As it runs up the thigh, it remains on the medial side.
• The femoral triangle, at the top of the thigh and pelvis, is accessed by the great saphenous vein via an opening called the saphenous opening. It is here—at what’s called the saphenofemoral junction—that it terminates into the femoral vein. There’s a valve at this spot, as it separates more superficial (surface) structures from deeper veins.

Anatomical Variations

As with many vessels in the body, variations of the anatomy of the great saphenous vein do occur. There are actually many differences that can occur, and they tend to vary based on their location along the course. These may or may not lead to functional difficulties or other issues and can be broken into three broad types:

• Segmental hypoplasia: Segments or portions of the great saphenous vein may be underdeveloped (hypoplastic) or completely absent (aplastic) at birth. This is typically seen in and around the knee, though it can occur above or below that.
• Accessory vein(s): Secondary, smaller veins can accompany the great saphenous vein at any portion of its course. This doubling is not, in itself, problematic, though it increases the chance of veins become varicose.
• Duplication: A very rare case, occurring about 1% of the time, is duplication of the great saphenous vein, which is often confused with the development of an accessory one. In these cases, however, the two veins are the same size. This is largely a harmless condition, though it can also lead to the development of varicose veins.

Function

The primary job of the great saphenous vein is to convey deoxygenated blood from the surfaces and deeper veins of the lower limbs back to the heart. Throughout its course, both major and minor veins are involved in this task, including:

• The medial marginal vein helps form the origin of the great saphenous vein and drains blood from the sole of the foot.
• The small saphenous vein drains the lateral surfaces in the upper foot, ankle, and parts of the leg.
• Tibial veins—of which there is an anterior and a posterior one—drain from the foot, ankle, and leg, before uniting and forming the popliteal vein in the back of the knee.
• Veins in the thigh, including the accessory saphenous, anterior femoral cutaneous, superficial epigastric, superficial circumflex iliac, and superficial external pudendal veins, collect blood from both surface and deeper tissues of the leg and thigh.

Clinical Significance

The great saphenous vein also has clinical applications. Because of its position close to the surface of the skin, it offers easy access for sampling blood.

This, along with its size, also makes this vein a good candidate for harvesting to use in coronary artery bypass graft (CABG) surgery. This treatment for issues like heart attack and heart failure involves using portions of the great saphenous vein to replace coronary arteries.

Associated Conditions

As with all parts of the circulatory system, the great saphenous vein can become diseased or impacted by other conditions. Given its size and significant role, these can lead to significant issues. Primarily, this vessel is associated with:

• Varicose veins: When veins cannot properly deliver blood back to the heart, they can become engorged and sensitive to the touch. This occurs when valves of the greater saphenous vein aren’t functioning properly, which can be the result of pregnancy, chronic heart disease, genetics, obesity, or frequent and prolonged standing.
• Thrombophlebitis: This clotting of the great saphenous vein can be accompanied by inflammation, which impacts circulation leading to swelling, redness, and pain in affected areas. This can occur due to pancreatic cancer, being immobile for a long time, and trauma or accident.

Rehabilitation

Care for conditions involving the great saphenous vein can mean anything from making lifestyle changes and managing underlying problems to surgery. It very much depends on the specific case, and sometimes multiple strategies are needed.

Here’s a quick breakdown of what rehabilitation of this vessel can look like:

• Lifestyle adjustments: Especially with varicose veins, making changes in diet, exercise, or other habits (such as quitting smoking) can help improve circulation and manage symptoms.
• Compression stockings: Both varicose veins and thrombophlebitis may be helped by wearing compression stockings and keeping legs elevated.
• Prescribed medications: For thrombophlebitis, you may be prescribed painkillers, anti-inflammatory drugs, or even blood thinners such as Coumadin (warfarin). Vasculera (diosmiplex) is an oral medication approved for varicose veins.
• Thermal ablation: Also known as endovenous ablation, varicose veins can be treated using this approach. Via catheter, heat is delivered to problematic areas, sealing off affected veins.
• Sclerotherapy: This treatment approach relies on injecting a special medicated solution into problematic veins, causing them to swell and turn into scar tissue. This, in turn, helps correct blood circulation issues and causes disfiguration to disappear.  
• Surgery: Though rarely employed, surgical stripping of problematic veins can also take on difficult cases of varicose veins. A long-established approach, contemporary techniques rely on smaller incisions and tend to be less invasive.