# Cadaveric Analysis of Valvular Anatomy in the Great Saphenous Vein: Implications for Surgical Planning

## TL;DR

This study analyzes the valve distribution in the great saphenous vein to improve surgical planning for vascular bypass procedures.

## Contribution

The study provides new anatomical data on GSV valve distribution and spacing, relevant for surgical graft selection.

## Key findings

- Left GSVs had an average of 5.7 valves and right GSVs had 5.5 valves.
- Valve distribution and spacing differed significantly above and below the knee.
- Below-knee segments have fewer valves and greater inter-valve distances, suggesting suitability for grafting.

## Abstract

Introduction and aim

Coronary artery disease and peripheral vascular disease remain significant health concerns in the United States. If left untreated, surgical interventions like coronary artery bypass grafting (CABG) and peripheral vascular bypass (PVB) are frequently performed to restore vascular perfusion. The great saphenous vein (GSV) has historically been a primary conduit for these procedures. Complications involving the GSV include early-onset thrombosis and atherosclerosis, which are partly attributed to tunica intima valve flaps. These flaps can disrupt laminar flow even when the GSV is reversed. However, the GSV continues to play a crucial role in multi-vessel revascularization and PVB surgeries. This study aimed to analyze the GSV’s anatomical characteristics, particularly the distribution and spacing of its valves.

Methods

Cadaveric specimens were examined from 2021 to 2024. The GSV was incised, valve locations were marked and measured in relation to the inferior base of medial malleolus. Statistical analyses, including Student’s t-tests and ANOVA, were performed to assess differences.

Results

Results from 96 GSVs across 66 cadavers indicated an average of 5.7 valves per left GSV and 5.5 per right GSV. Significant differences were found between valve distributions above vs. below the knee (p<0.001), with increased inter-valve distance below the knee (p<0.001).

Conclusion

These data suggest that below knee segments may be more suitable for grafting because they have fewer valves and increased inter-valve distance. This study has the potential to provide insights for optimizing vein graft selection and improving surgical outcomes.