You are in: eMedicine Specialties > Clinical Procedures > Vascular Techniques Cutdown, Saphenous VeinArticle Last Updated: Oct 31, 2008AUTHOR AND EDITOR INFORMATIONSection 1 of 14
  Author: Matthew A Silver, MD, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine; Assistant Residency Director, Albert Einstein College of Medicine Jacobi/Montefiore Emergency Medicine Training Program; Consulting Staff, Department of Emergency Medicine, Montefiore Medical Center Matthew A Silver is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Phi Beta Kappa, and Society for Academic Emergency Medicine Coauthor(s): Louis Gelabert, PA, Physician Assistant, Emergency Department, Montefiore Medical Center Editors: Andrew K Chang, MD, Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine; Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center; Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT; Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital Author and Editor Disclosure Synonyms and related keywords: saphenous vein, saphenous vein cutdown, saphenous access, vascular access, emergency vascular access, greater saphenous vein, long saphenous vein, saphenous vein access, venous cutdown, venotomy, venesection, fluid resuscitation, fluid administration, emergent vascular access, emergent bedside vascular access, venectomy, short saphenous vein, vein transsection, vein thrombosis, air embolism, peripheral access, emergency access OVERVIEWSection 2 of 14
  Intravenous access is one of the crucial first steps in the resuscitation of any critically ill or injured patient who presents to the emergency department. When peripheral intravenous access fails, alternative routes must be sought to obtain rapid access for the purpose of infusing intravenous fluids, blood products, or medications.1 Although the venous cutdown has largely been replaced by over-the-wire percutaneous catheters (also known as central lines)2, it remains an excellent alternative when other approaches have failed.1 The technique has been well described in the pediatric literature,3, 4 where venipuncture may be more difficult secondary to nonvisible or nonpalpable peripheral veins.5 In infants and children, however, the cutdown has largely been replaced by intraosseous access as a secondary route of access and is only recommended when all other methods have failed.6, 7 For a comparison of vascular access methods, see eMedicine article Vascular Access: Surgical Perspective. The greater saphenous vein is the most common vessel used for the venous cutdown.8 Although the procedure can be performed at multiple sites along the length of the saphenous vein, it is commonly performed at the ankle because the predictable and superficial location of the vein in this area allows it to be exposed with minimal dissection. Moreover, in the midst of resuscitation, its location distant from the primary resuscitative efforts centered at the head, neck, and torso allow for unhindered accessibility to the site. Anatomy The greater, or long, saphenous vein, which is the longest vein in the body, originates at the ankle as a continuation of the medial marginal vein of the foot and ends at the femoral vein within the femoral triangle. At the ankle, it crosses 1 cm anterior to the medial malleolus and continues up the anteromedial aspect of the lower leg. It continues its superficial course and lies on the posteromedial aspect at the level of the knee. In the thigh, the greater saphenous vein courses anterolaterally through the fossa ovalis, where it joins the femoral vein approximately 4 cm below the inguinal ligament.  Anatomy of the greater saphenous vein. The lesser saphenous vein, also known as the short saphenous vein, does not directly anastomose with the greater saphenous vein. It begins at the lateral aspect of the ankle and runs up the posterolateral lower leg to join the popliteal vein in the popliteal fossa. INDICATIONSSection 3 of 14
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eMedicine from WebMD: Shock, Hypovolemic American College of Surgeons. Advanced Trauma Life Support for Doctors: Student Course Manual. 6th ed. Chicago, Ill: American College of Surgeons;1997:121-4. Chen H, Sonnenday CJ, Lillemoe KD. Manual of Common Bedside Surgical Procedures. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins;2000:63-6. ACKNOWLEDGMENTSSection 12 of 14
The authors and editors of eMedicine gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article. MULTIMEDIASection 13 of 14
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Cutdown, Saphenous Vein excerpt Article Last Updated: Oct 31, 2008 | ||||||||||||
