Corpus: Great saphenous vein

The great saphenous vein, or GSV for short, is the largest superficial vein of the lower extremity and can exhibit considerable variability in shape.

The great saphenous vein originates near the medial edge of the foot from the dorsal venous arch, where the dorsal vein of the big toe meets the vascular arch. The initial segment of the vessel is sometimes referred to as the medial marginal vein.

The vein runs anterior to the medial malleolus, alongside the saphenous nerve, cranially along the tibia to the knee. On the medial side of the knee, it crosses over the posterior edge of the medial femoral epicondyle to the thigh. In the proximal third of the thigh, it joins the venous star, pierces the cribriform fascia in the saphenous hiatus, and ultimately drains into the femoral vein.

At the venous star, the following superficial veins converge with the great saphenous vein: superficial epigastric vein, superficial circumflex iliac vein, external pudendal veins, and the variably developed accessory saphenous vein.

The great saphenous vein has numerous anastomoses to the deep leg veins via the system of perforating veins.

2.1. Tributaries

• Lateral saphenous vein
• Medial saphenous vein
• Anterior arcuate vein of the leg
• Posterior arcuate vein of the leg
• Superficial epigastric vein

The great saphenous vein has the typical three-layered wall structure of venous blood vessels, consisting of the intima, media, and adventitia. It is characterized by a particularly high incidence of venous valves.

4.1. Varicosis

Like other leg veins, the great saphenous vein can be affected by varicosis (varicose veins).

4.2. Thrombosis

Thrombosis of the great saphenous vein is not life-threatening per se. However, the thrombosis can extend into the deep leg veins via perforating veins, potentially leading to deep vein thrombosis.

4.3. Use as a vascular graft

The great saphenous vein has historically been one of the most frequently used vessels for bypass grafts. Its removal is feasible due to the presence of sufficient collateral circulation, and it is easily accessible surgically due to its anatomical position. The great saphenous vein remains the preferred graft for extremity bypass surgery. However, arterial vessels are currently (2021) preferred for coronary artery bypasses due to significantly higher long-term success rates.

GSV grafts are generally better suited as autologous vascular grafts than synthetic vascular prostheses.