Small saphenous vein !

The small saphenous vein is a surface vein that runs from the outer foot, behind the outer ankle, up the back of the calf.

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What it is

A surface vein that starts on the outer edge of the foot, passes behind the outer ankle bone and runs up the back of the calf.

What it does

Drains blood from the skin into the popliteal vein behind the knee.

Key facts

Drains: Lateral end of dorsal venous arch, behind lateral malleolus; posterior leg (runs with sural nerve)
Into: Popliteal vein in popliteal fossa (varies: may end higher, in femoral or great saphenous vein)

Relations

Course: From the lateral end of the dorsal venous arch it passes behind the lateral malleolus, runs up beside the lateral border of the Achilles tendon to the midline of the calf, pierces the deep fascia and ends in the popliteal vein in the fossa
Deep: The two heads of gastrocnemius, with the medial sural cutaneous nerve beside it in the groove between them
Above: A cranial extension may continue up the back of the thigh; when it joins the great saphenous vein it is called the Giacomini vein

How to find it

With the person standing and facing away, it is seen behind the lateral malleolus and along the outer edge of the Achilles tendon, then up the middle of the calf. It disappears from view in the upper calf, where it runs under the deep fascia.

Examination

Duplex ultrasound with the person standing: reflux lasting more than 0.5 seconds at the saphenopopliteal junction after a calf squeeze is released confirms that the junction is incompetent
Tourniquet test below the knee crease: if the posterior calf varicosities stay empty on standing with the band in place, the leak is at the saphenopopliteal junction (largely replaced by duplex)

On imaging

Duplex ultrasound with the patient standing: in a transverse view of the calf it sits in a fascial compartment between the two gastrocnemius heads, near the sural nerve. The scan marks the level of the saphenopopliteal junction and tests for reflux, shown as backward flow after a calf squeeze. A thrombus shows as a non-compressible vein. CT and MRI are rarely needed.

Common problems

Varicose veins.

Clinical notes

Saphenopopliteal reflux causes varicose veins on the back and outer side of the calf
Superficial thrombophlebitis near the junction can extend into the popliteal vein
An alternative bypass conduit when the great saphenous vein is missing or unsuitable
Surgery at the junction also puts the tibial nerve and common fibular nerve at risk, as they lie close by in the popliteal fossa
Superficial lymph vessels from the lateral foot and back of the calf run with it to the popliteal nodes, so infection there may enlarge popliteal nodes before groin nodes

Anatomical variants

Often ends higher than the fossa: in the femoral vein, in the great saphenous vein through the Giacomini vein, or in deep thigh veins
Less often ends lower, in the gastrocnemius veins or in the great saphenous vein in the calf
The point where it pierces the deep fascia varies from the lower to the upper calf

Development

It comes from the postaxial (fibular-side) marginal vein of the limb bud, the counterpart of the great saphenous vein on the preaxial side.

Test yourself

Think of the answer, then tap the question to see it.

Where does the small saphenous vein usually end?

In the popliteal vein at the saphenopopliteal junction, but the level varies so much that it is marked on duplex ultrasound before any procedure.

Which nerve runs with the small saphenous vein, and what can its surgery leave?

The sural nerve; surgery or ablation on the vein can leave numbness along the lateral foot.

Where does the small saphenous vein begin and run in the lower leg?

From the lateral end of the dorsal venous arch, behind the lateral malleolus and beside the lateral border of the Achilles tendon.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): vena saphena parva TA2 5085
Official Spanish (DeCS): Vena safena menor DeCS D012501
English (TA2): Small saphenous vein
Also called: short saphenous vein

Sources: Terminologia Anatomica (TA2); DeCS; Anatomy, Bony Pelvis and Lower Limb: Popliteal Region; Tratado de anatomía humana (9.ª ed.), tomo II, Libro IV Angiología, sección 5: Linfáticos.

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Representative model, for educational purposes only.

Small saphenous vein highlighted on the Durgical 3D model