Where is the Great Saphenous Vein (GSV)?
The Great Saphenous Vein (GSV) runs from the inner aspect of the ankle, up the inner aspect of the leg, on the inside and slightly behind the knee, up the inside of the thigh winding onto the front of the thigh and joins the deep-vein (called the Common Femoral Vein) at the groin.
It lies on the inside of the fat layer of the leg, deeper under the skin than many visible veins but outside of the muscle. It is surrounded by a sheath of connective tissue, called the saphenous fascia, which is very useful when it comes to directing local anaesthetic around the Great Saphenous Vein (GSV) itself.
Because it lies within the fat, it is rarely visible on normal people. In slim people, the bottom part of the Great Saphenous Vein (GSV) can be seen at the ankle, just in front of the ankle bone on the inside of the ankle (a bone called the medial malleolus). However, unless the person is very thin, the vein is too deep to see through the skin above this point.
As with all veins, there are many tributaries taking blood into the vein all of the way up its length. In the lower leg, a nerve called the saphenous nerve runs very close to the Great Saphenous Vein (GSV). It is for this reason that most treatments of the Great Saphenous Vein (GSV) are restricted to the part of the vein between a point just below the knee and up to the groin, but rarely in the lower leg.
Treatment of the Great Saphenous Vein (GSV) in the lower leg gives a much higher risk of nerve damage and loss of sensation of the inner aspect of the lower leg and foot. Therefore, as there is rarely a clinical need to treat this part of the vein, treatment usually stops above this point to reduce the risk of nerve damage.
Very occasionally, in patients with severe skin changes or ulcers at the ankle, with proven gross reflux of blood in this lower part of the vein, it may need to be treated. In these rare patients, the surgeon or treating doctor will discuss the risks and warn the patient of this potential complication before treatment.