The Intersaphenous Veins in the Leg: Anatomical Considerations

Abstract

Background

The intersaphenous veins are inconstant veins interconnecting the great and the small saphenous veins. Due to the inclination of the superficial venous system to be rather inconsistent, this topic has never been described thoroughly and adequately before. The aim of our research was to observe intersaphenous veins and give a profound description of their variable anatomy.

Methods

Sixty-three body donor limbs of Central European origin embalmed in formaldehyde were dissected. The tips of the medial and lateral malleoli were selected as suitable points of reference for measurements on the vertical axis of the leg. Additionally, each fibula was measured and related to the average length of the fibula in our examined sample. Consequently, each measurement was recalculated by this coefficient.

Results

Five types of arrangement were described: no connection (22.22%), one connection (46.03%), two connections (19.05%), three connections (11.11%), and four connections (1.59%). The average point of communication between the great saphenous vein and the intersaphenous vein was located 21.50 ± 9.64 cm proximal to the medial malleolus and between the small saphenous vein and the intersaphenous vein, 18.45 ± 6.05 cm proximal to the lateral malleolus. Multiple heatmaps were created for an easier comprehension of the topic.

Conclusion

This research provides a detailed anatomy of intersaphenous veins of the leg. Yet variable in their arrangement, intersaphenous veins were found in the majority of investigated limbs. Thanks to their favorable anatomy, intersaphenous veins offer new alternatives to the traditional venous grafts from the saphenous veins, not only for heart bypasses.

Keywords

great saphenous vein - intersaphenous veins - leg - small saphenous vein - superficial veins - venous graft

• References

• 1 Kachlik D, Pechacek V, Baca V, Musil V. The superficial venous system of the lower extremity: new nomenclature. Phlebology 2010; 25 (03) 113-123
• 2 Uhl J-F, Gillot C. Anatomy of the foot venous pump: physiology and influence on chronic venous disease. Phlebology 2012; 27 (05) 219-230
• 3 Caggiati A, Bergan JJ, Gloviczki P, Jantet G, Wendell-Smith CP, Partsch H. International Interdisciplinary Consensus Committee on Venous Anatomical Terminology. Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement. J Vasc Surg 2002; 36 (02) 416-422
• 4 Natsis K, Paraskevas G, Lazaridis N, Sofidis G, Piagkou M. Giacomini vein: thigh extension of the small saphenous vein - report of two cases and review of the literature. Hippokratia 2015; 19 (03) 263-265
• 5 Thomson H. The surgical anatomy of the superficial and perforating veins of the lower limb. Ann R Coll Surg Engl 1979; 61 (03) 198-205
• 6 Kim R, Lee W, Park E-A, Yoo JY, Chung JW. Anatomic variations of lower extremity venous system in varicose vein patients: demonstration by three-dimensional CT venography. Acta Radiol 2017; 58 (05) 542-549
• 7 O'Donnell Jr TF, Iafrati MD. The small saphenous vein and other ‘neglected’ veins of the popliteal fossa: a review. Phlebology 2007; 22 (04) 148-155
• 8 Mozes G, Carmichael SW, Gloviczki P. Surgical anatomy of the veins of the lower limb. Perspect Vasc Surg Endovasc Ther 2000; 12 (02) 107-116
• 9 Mozes G, Gloviczki P. New discoveries in anatomy and new terminology of leg veins: clinical implications. Vasc Endovascular Surg 2004; 38 (04) 367-374
• 10 Black CM. Anatomy and physiology of the lower-extremity deep and superficial veins. Tech Vasc Interv Radiol 2014; 17 (02) 68-73
• 11 Oğuzkurt L. Ultrasonographic anatomy of the lower extremity superficial veins. Diagn Interv Radiol 2012; 18 (04) 423-430
• 12 Meissner MH. Lower extremity venous anatomy. Semin Intervent Radiol 2005; 22 (03) 147-156
• 13 Cavezzi A, Labropoulos N, Partsch H. et al. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs–UIP consensus document. Part II. Anatomy. Eur J Vasc Endovasc Surg 2006; 31 (03) 288-299
• 14 Harskamp RE, Lopes RD, Baisden CE, de Winter RJ, Alexander JH. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Ann Surg 2013; 257 (05) 824-833
• 15 Veverková L, Jedlicka V, Vlcek P, Kalac J. The anatomical relationship between the saphenous nerve and the great saphenous vein. Phlebology 2011; 26 (03) 114-118
• 16 Akagi D, Arita H, Komiyama T. et al. Objective assessment of nerve injury after greater saphenous vein stripping. Eur J Vasc Endovasc Surg 2007; 33 (05) 625-630
• 17 Hwee J, Tan BK, Hattori Y. Use of the short saphenous vein graft in microsurgical reconstruction. Arch Plast Surg 2020; 47 (03) 282-286
• 18 Barner HB, Farkas EA. Conduits for coronary bypass: vein grafts. Korean J Thorac Cardiovasc Surg 2012; 45 (05) 275-286
• 19 Park S, Han SH, Lee TJ. Algorithm for recipient vessel selection in free tissue transfer to the lower extremity. Plast Reconstr Surg 1999; 103 (07) 1937-1948
• 20 Yazar S, Lin CH. Selection of recipient vessel in traumatic lower extremity. J Reconstr Microsurg 2012; 28 (03) 199-204
• 21 Hayashi K, Futamura K, Tsuchida Y. et al. The influence of the level of injury on the selection of recipient vessels in severe open fractures of the tibia and foot. J Reconstr Microsurg 2025
• 22 Mirhosseini SM, Soltanipur M, Yarmohammadi H, Rezaei M, Sheikhi Z. Lymphedema after saphenous harvesting for coronary artery bypass surgery: case report and literature review. BMC Cardiovasc Disord 2024; 24 (01) 41