Anatomical considerations of the venous drainage of the lower extremities: clinical implications

The anatomical course, branches, valve distribution, and perforators of the long saphenous vein were described in 59 patients. Altogether, 95 legs were dissected while obtaining the vein for coronary artery bypass procedures. The findings indicated that the first valve is located 12.7 +/- 7.1 cm from the ankle, the second 21.1 +/- 7.4 cm, and the third 25.4 +/- 5.5 cm. The branches are located at 14.2 +/- 6.5 cm and the second is 20.4 +/- 7.9 cm. The perforators indirectly connected were present at 16.3 +/- 6.25 cm and 24.0 +/- 2.6 cm. Based on the anatomy of valves, branches, and perforators the areas of vulnerability and disease in the long saphenous system are localized in the area of 12 to 16 and 20 to 25 cm from the ankle. The most probable location of the first branch, perforator, or valve is between 12 to 16 cm from the ankle, probability of 0.70. The valve and the branch distributions of the long saphenous vein on the lower extremities are consistent. The "tier" arrangement of the venous drainage and the supporting role of the membranous fascia were also emphasized. These observations seem to be, in some respect, controversial to the general accepted anatomical descriptions.