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Disclosure
Paul M. McNeill, M.D.
I have no financial relationship(s) to disclose.
The Great Saphenous
Vein
Paul M. McNeill, MD FACS
Capitol Vein and Laser Center
Bethesda, Maryland
Great Saphenous Vein
 Path of the GSV
 Key branches
 Supporting
structures
 Relationship to
nerves
 Vein valve functi...
Great Saphenous Vein
 Ascends the medial
aspect of the leg and
thigh
 Venous drainage of the
skin and subcutaneous
tissu...
Great Saphenous Vein
 Veins of the lower
extremity
• Return blood to the
central circulation
• Deep venous system
 Prima...
Great Saphenous Vein
 Veins of the lower
extremity
• Return blood to the
central circulation
• Deep venous system
 Prima...
Great Saphenous Vein
 Veins of the lower
extremity
• Return blood to the
central circulation
• Deep venous system
 Prima...
Great Saphenous Vein
 Veins of the lower
extremity
• Return blood to the
central circulation
• Deep venous system
 Prima...
Superficial veins of the foot
 Dorsal Venous Arch
• Lateral end of DVA
drains into SSV
• Proximal to Metatarsal
heads
• M...
Great Saphenous Vein
 At the ankle the GSV is apparent on
physical examination
 The superficial presentation of the
vein...
Great Saphenous Vein –
Leg Branches
 Duplicate saphenous
vein BK in 30%
 Two major branches
below the knee
 The Posteri...
Medial Calf Perforating Veins
Great Saphenous Vein –
Thigh Branches
 Fascial layers create a
sheath around the GSV
 Two major branches
above the knee
...
Saphenofemoral Junction
Saphenofemoral Junction Variation
Saphenous Compartment
 Fascial envelope
 Upper calf to groin
 Deep fascia
 Scarpa’s fascia
 GSV: 3-4mm diameter
 Dup...
Saphenous Nerve
 Femoral n branch
 Subsartorial canal
 Proximal ½ posterior
 Lower 1/3 anterior
 Adherent to GSV
• Me...
Anatomic Overview
Vein Wall
 Intima
 Media
 Adventitia
 Endothelia cells
prevent thrombosis
 Muscular
contraction alt...
Anatomic Overview
Compartments of the leg
 Superficial and
deep
compartments
 Fascial envelope
• Defines high
pressure d...
Anatomic Overview
Calf Muscle Pump
 Muscles enclosed
in fascial envelope
 Muscular
contraction raises
pressure
 Venous
...
Venous Histology: Vein Valve
 Thin sheets of
collagen
 Smooth muscle
 Endothelium
 Muscle fibers at
base
 Elastic fib...
Vein Valves
 Blood propelled
by calf muscle
pump opens the
valve in one
direction
 Blood moving
with gravity
closes the ...
Saphenous Reflux
 Disruption of the one way
valve system
• Primary
• Secondary
 Sequential valve failure
 High pressure...
Saphenous Vein Reflux
Reflux Schemes
 Normal valve
function
 Perforating vein
has one way
flow
 Fascia separates
deep and
superficial
compart...
Reflux Schemes
 Relationship of
superficial veins to
GSV vein valves
 Normal caliber of
veins throughout
system
 Low pr...
Reflux Schemes
 Perforator vein
incompetence
 Dilated GSV
 Dilated GSV branch
vein
 Higher venous
pressure in superfic...
Reflux Schemes
 Increasing pressure
results in valve failure
 Additional vein branches
become varicose
 Further GSV
inc...
Great Saphenous Vein
Great Saphenous Vein
Great Saphenous Vein
Great Saphenous Vein
Great Saphenous Vein
GSV Tortuosity
GSV Tortuosity
GSV Stenosis
Duplex Assessment
GSV Position – Close to Dermis
Great Saphenous Vein
57M, Denies Symptoms
TSA Search and Refer
Thank You
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The Great Saphenous Vein

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By: Paul M. McNeill, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.

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The Great Saphenous Vein

  1. 1. Disclosure Paul M. McNeill, M.D. I have no financial relationship(s) to disclose.
  2. 2. The Great Saphenous Vein Paul M. McNeill, MD FACS Capitol Vein and Laser Center Bethesda, Maryland
  3. 3. Great Saphenous Vein  Path of the GSV  Key branches  Supporting structures  Relationship to nerves  Vein valve function  Pathophysiology  Anatomy impacting treatment
  4. 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. 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. 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. 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. 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. 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. 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. 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
  12. 12. Medial Calf Perforating Veins
  13. 13. Great Saphenous Vein – Thigh Branches  Fascial layers create a sheath around the GSV  Two major branches above the knee  ISV connects GSV,SSV  Medial Thigh Perforators  Duplicate GSV 8%  Saphenofemoral Junction
  14. 14. Saphenofemoral Junction
  15. 15. Saphenofemoral Junction Variation
  16. 16. Saphenous Compartment  Fascial envelope  Upper calf to groin  Deep fascia  Scarpa’s fascia  GSV: 3-4mm diameter  Duplex identification  Tumescent anesthetic technique  Veins outside the sheath are GSV Tributaries Images courtesy of Olivier Pichot, MD
  17. 17. Saphenous Nerve  Femoral n branch  Subsartorial canal  Proximal ½ posterior  Lower 1/3 anterior  Adherent to GSV • Medial malleolus 80% • Mid leg 97%
  18. 18. Anatomic Overview Vein Wall  Intima  Media  Adventitia  Endothelia cells prevent thrombosis  Muscular contraction alters vein volume
  19. 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. 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. 21. Venous Histology: Vein Valve  Thin sheets of collagen  Smooth muscle  Endothelium  Muscle fibers at base  Elastic fibers
  22. 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. 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
  24. 24. Saphenous Vein Reflux
  25. 25. Reflux Schemes  Normal valve function  Perforating vein has one way flow  Fascia separates deep and superficial compartments  GSV normal
  26. 26. Reflux Schemes  Relationship of superficial veins to GSV vein valves  Normal caliber of veins throughout system  Low pressure maintained
  27. 27. Reflux Schemes  Perforator vein incompetence  Dilated GSV  Dilated GSV branch vein  Higher venous pressure in superficial system
  28. 28. Reflux Schemes  Increasing pressure results in valve failure  Additional vein branches become varicose  Further GSV incompetence and dilation
  29. 29. Great Saphenous Vein
  30. 30. Great Saphenous Vein
  31. 31. Great Saphenous Vein
  32. 32. Great Saphenous Vein
  33. 33. Great Saphenous Vein
  34. 34. GSV Tortuosity
  35. 35. GSV Tortuosity
  36. 36. GSV Stenosis
  37. 37. Duplex Assessment
  38. 38. GSV Position – Close to Dermis
  39. 39. Great Saphenous Vein
  40. 40. 57M, Denies Symptoms
  41. 41. TSA Search and Refer
  42. 42. Thank You
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By: Paul M. McNeill, M.D. Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.

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