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Saphenous Vein Graft

The saphenous vein is an autologous vascular conduit with a small but persistent role in reconstructive urology. Its dominant urologic application is as graft material for tunical lengthening in Peyronie's disease, where it sits alongside tunica albuginea, pericardium, and small intestinal submucosa as a workhorse autologous option. Secondary applications include penile revascularization for vasculogenic erectile dysfunction, vascular salvage during kidney transplantation, intraoperative pelvic venous-injury repair, and as the conduit of choice for aortorenal bypass in open renovascular reconstruction. It has no established role in urogynecology.[1][2][3]

See the overview article for graft-selection principles: Grafts in GU Reconstruction. For Peyronie's disease as a clinical entity see Peyronie's disease.

Why the Saphenous Vein for Genitourinary Reconstruction?​

The great saphenous vein is attractive in GU reconstruction for several reasons:

  • Autologous — no rejection, no infection-prone synthetic material
  • Reliable accessible donor site — long, predictable course from medial malleolus to femoral triangle
  • Pliable, thin-walled — handles like tunica when patched onto corporal defects
  • Familiar harvest — most urologists have experience from training or vascular co-cases
  • Two-team possible — leg harvest and corporal exposure can proceed simultaneously, shortening operative time
  • Long lengths available — full saphenous run yields > 60 cm if needed for spiral or composite grafts

Trade-offs include donor-site numbness, pain, and wound complications (well-characterized in the cardiac surgery literature — see Donor-Site Morbidity below), and a thin-walled, low-resistance design that is excellent for vascular conduit but suboptimal for the structural-support requirements of pelvic-floor reconstruction.[4]

1. Peyronie's Disease — Plaque Incision and Vein Grafting​

The most established and widely studied urologic application. After plaque incision or partial excision, the resulting tunical defect is reconstructed with a harvested saphenous vein patch — the plaque incision and vein graft (PIVG) procedure.

Indications. Saphenous vein and tunica albuginea are the most commonly used autologous graft materials for tunical lengthening in Peyronie's disease, indicated for:[1]

  • Curvature > 60°
  • Severe length loss
  • Prominent hourglass deformity
  • Combined deformities not amenable to plication

Outcome series​

StudynProcedureFollow-upKey results
Montorsi 2000[5]50Plaque incision + saphenous vein graftMean 32 moComplete straightening 80%; minor residual curvature (≤ 30°) 14%; significant recurrence 6%. Penile rigidity preserved 94%. Slight shortening 40%. Doppler vascular impairment 10%.
Yurkanin 2001[6]24Plaque incision + saphenous vein graft—Mean penile length increased 2.1 cm (p < 0.001); high satisfaction.
Austoni 2005[7]145Soft prosthesis implant + relaxing albugineal incision + saphenous vein grafting5 yr~1.5 cm lengthening; 95% patient satisfaction at 12 mo. Specifically addresses the penile-shortening problem of traditional Peyronie's surgery.
Danacıoğlu 2021[8]41Saphenous vein vs buccal mucosa graft12 moNo significant difference in IIEF, satisfaction, or residual curvature (13.1% SV vs 11.2% BM).

The technique was systematized by Lue and El-Sakka 1998, who described H-shaped tunical incisions with assembly of multiple vein segments using a vascular stapler to cover larger defects.[9] Saphenous vein remains a contemporary first-line autologous graft option for PIVG, with comparative data showing equivalence to buccal mucosa.[8]

2. Penile Revascularization for Vasculogenic Erectile Dysfunction​

Saphenous vein has been used as an interposition conduit for penile arterialization in select patients with arteriogenic ED.

  • Wagenknecht technique — interposition of a saphenous vein graft between the iliac artery and the deep dorsal penile vein, achieving satisfactory erections in two-thirds of patients at 2 years. Failures were predominantly in diabetic patients.[10][11]
  • Contemporary penile revascularization has largely shifted to direct microvascular anastomosis of the inferior epigastric artery to the dorsal penile artery (without saphenous interposition), reserved for young men (< 55 yr) with focal post-traumatic arterial disease and no venogenic component.[12][13]
  • Penile revascularization remains a highly selective and controversial procedure. Only Grade D recommendations exist, and strict selection criteria (age < 55, focal disease, no diabetes / smoking / generalized atherosclerosis, intact venous occlusion) are essential.[14][12]

3. Vascular Salvage During Kidney Transplantation​

Saphenous vein interposition is an established salvage technique for complex vascular situations during kidney transplantation:[15][16]

  • Short renal vein (right donor kidneys especially) — a saphenous vein graft can extend the renal vein to facilitate anastomosis to the external iliac vein. Shimizu 2018 used a 1-cm saphenous vein graft for a right donor kidney with a short renal vein; good postoperative function.[16]
  • Arterial complications — iatrogenic vascular accidents, arterial plaques, hemodynamically significant polar arteries, horseshoe kidneys. Oertl 2007 reported saphenous vein interposition as a salvage technique in a series of 100 transplantations with acceptable outcomes.[15]
  • Alternative conduits include the gonadal vein and superficial femoral vein, which may offer better size matching in selected scenarios.[17][18]

4. Intraoperative Pelvic Venous-Injury Repair​

The saphenous vein is a readily available autologous graft for major venous injuries encountered during pelvic urologic surgery (radical prostatectomy, cystectomy, lymph-node dissection) when no vascular surgeon is immediately available. Dalton 1979 described the original techniques of saphenous-vein patch and replacement grafts for major pelvic venous injuries, and the principle remains unchanged: harvest from the same operative field, patch or replace as needed, restore venous return.[19]

5. Aortorenal Bypass for Renovascular Disease​

For open renal artery revascularization, saphenous vein is the most commonly used conduit for aortorenal bypass, with the AHA 2022 statement noting that conduit options include saphenous vein, hypogastric artery, and synthetic graft — saphenous vein preferred in most adults.[20][21]

ConsiderationDetail
Adult durabilitySaphenous vein grafts are more durable in the renal artery bed than in coronary or peripheral beds — the low-resistance, high-velocity renal flow protects against intimal hyperplasia and atherosclerotic degeneration[22]
Children and young adultsSaphenous vein may undergo late aneurysmal degeneration — hypogastric artery is preferred when feasible[21]
Aneurysmal ruptureFrank aneurysmal degeneration with rupture of renal vein grafts is extremely rare (isolated case reports)[22]
Contemporary roleOpen renal revascularization fell from 1.3 → 0.3 per 100,000 adults between 1988 and 2009 with the rise of endovascular techniques. Now reserved for failed endovascular procedures, complex branch lesions, or concomitant aortic surgery[21]

6. IVC and Iliac Vein Reconstruction During Urologic Cancer Surgery​

During radical nephrectomy for renal-cell carcinoma with IVC tumor thrombus or during retroperitoneal sarcoma resection, vascular reconstruction may be required. Bovine pericardium and PTFE grafts have largely supplanted saphenous vein for IVC reconstruction (bovine pericardium is now used in ~86% of contemporary IVC reconstructions),[23] but saphenous vein retains specific niche roles:

  • Spiral saphenous vein grafts — constructed by wrapping the saphenous vein around a syringe scaffold to create a larger-diameter conduit matching the IVC or iliac vessels. Preferred in contaminated fields (e.g., concomitant bowel resection during pelvic exenteration) where synthetic grafts carry higher infection risk.[24]
  • Gloviczki 1990 reported spiral saphenous vein grafts as the first-choice for superior vena cava replacement, though for abdominal IVC reconstruction PTFE performed better.[25]
  • Saphenous vein patch grafts remain an option for smaller venous defects or when biologic / synthetic grafts are unavailable.[23]

(Cancer-resection IVC reconstruction sits in WARWIKI's gray zone — included here as the reconstructive consequence of an extirpative oncologic operation.)

7. Experimental — Urethral and Ureteral Reconstruction​

Both applications remain preclinical:

  • Urethral reconstruction (Kim 2014) — autologous saphenous vein graft as a ventral onlay in a rabbit urethral-stricture model. Complete urothelial re-epithelialization of the graft by 12 weeks; urethral caliber comparable to controls; no fistula.[26]
  • Ureteral reconstruction (Wolters 2010) — autologous vein graft + biodegradable endoluminal stent to replace 3 cm ureteral segments in a pig model. At 6 months the vein graft was relined with cytokeratin-7-positive urothelium; normal renal function; no hydronephrosis.[27]

These remain investigational. Established ureteral substitutes (BMG onlay, ileal interposition, appendix) are the contemporary clinical standards for upper-tract reconstruction.

Donor-Site Morbidity​

Saphenous-vein harvest morbidity is well characterized from the cardiac-surgery literature and applies directly to GU use.

ComplicationPrevalenceTimeline
Numbness / tingling61%41% persistent > 2 yr
Pain46%77% improved by 3 mo; 10% persistent > 2 yr
Wound infection (open harvest)10–32%Median detection 14 d post-op
Unilateral leg swelling41%23% persistent > 2 yr
Major wound complications requiring surgery0.65%Variable

Sources: Garland 2003,[28] Hassoun-Kheir 2018,[29] Paletta 2000.[30]

Independent risk factors for harvest-site complications: female sex (OR 4.08), BMI > 30 (OR 2.12), peripheral vascular disease (OR 3.33).[29]

Endoscopic vein harvest reduces wound complications from 14.2% to 5% vs open harvest (p ≤ 0.001) and is now standard in cardiac centers — a technique increasingly extended to urologic vein harvest.[31]

Summary of Applications​

ApplicationRole of saphenous veinCurrent status
Peyronie's disease graftingPrimary autologous graft optionEstablished, contemporary
Penile revascularization (ED)Interposition graftLargely superseded by direct microvascular anastomosis[12]
Renal transplant vascular salvageExtension of short renal vein; arterial-complication repairEstablished salvage technique[15][16]
Pelvic venous-injury repairPatch or replacement graftEstablished emergency technique[19]
Aortorenal bypassPreferred conduit in adultsNiche (endovascular era)[21]
IVC / iliac reconstruction (cancer)Spiral graft or patch; preferred in contaminated fieldsNiche; bovine pericardium dominant[23][24]
Urethral reconstructionVentral onlay graftPreclinical (animal model)[26]
Ureteral reconstructionVein graft + biodegradable stentPreclinical (animal model)[27]

No Established Role in Urogynecology​

Saphenous vein grafts have no established role in urogynecologic surgery. Pelvic reconstructive surgery for prolapse and incontinence relies on synthetic mesh (polypropylene), biologic grafts (porcine dermis, small intestinal submucosa, cadaveric fascia lata), and autologous fascia — but not vein.[32][33] The thin-walled, low-resistance properties of vein are well-suited to vascular conduit duty but poorly suited to the structural-support requirements of pelvic-floor reconstruction.

Key Takeaways​

The saphenous vein graft has a focused, durable role in reconstructive urology rather than a workhorse one. Its dominant urologic application is plaque incision and vein grafting (PIVG) for Peyronie's disease, where Montorsi 2000, Yurkanin 2001, and Austoni 2005 established 80–95% straightening / satisfaction with preserved rigidity, and Danacıoğlu 2021 confirmed equivalence to buccal mucosa.[5][6][7][8] Secondary applications — kidney-transplant vascular salvage, intraoperative pelvic venous-injury repair, aortorenal bypass, spiral-graft IVC / iliac reconstruction in contaminated fields, and historical penile revascularization — round out the urologic indication set.[15][19][21][24][10] Urethral and ureteral reconstruction with saphenous vein remain preclinical.[26][27] Donor-site morbidity (numbness 61%, pain 46%, wound infection 10–32% open / 5% endoscopic) is the principal trade-off and should be specifically counseled.[28][31]

See Also​

References​

1. Kadioglu A, Küçükdurmaz F, Sanli O. Current status of the surgical management of Peyronie's disease. Nat Rev Urol. 2011;8(2):95–106. doi:10.1038/nrurol.2010.233

2. Bhalla V, Textor SC, Beckman JA, et al. Revascularization for renovascular disease: a scientific statement from the American Heart Association. Hypertension. 2022;79(8):e128–43. doi:10.1161/HYP.0000000000000217

3. Jeon MJ, Bai SW. Use of grafts in pelvic reconstructive surgery. Yonsei Med J. 2007;48(2):147–56. doi:10.3349/ymj.2007.48.2.147

4. Garland R, Frizelle FA, Dobbs BR, Singh H. A retrospective audit of long-term lower limb complications following leg vein harvesting for coronary artery bypass grafting. Eur J Cardiothorac Surg. 2003;23(6):950–5. doi:10.1016/s1010-7940(03)00116-7

5. Montorsi F, Salonia A, Maga T, et al. Evidence based assessment of long-term results of plaque incision and vein grafting for Peyronie's disease. J Urol. 2000;163(6):1704–8.

6. Yurkanin JP, Dean R, Wessells H. Effect of incision and saphenous vein grafting for Peyronie's disease on penile length and sexual satisfaction. J Urol. 2001;166(5):1769–72; discussion 1772–3.

7. Austoni E, Colombo F, Romanò AL, et al. Soft prosthesis implant and relaxing albugineal incision with saphenous grafting for surgical therapy of Peyronie's disease: a 5-year experience and long-term follow-up on 145 operated patients. Eur Urol. 2005;47(2):223–9; discussion 229. doi:10.1016/j.eururo.2004.10.004

8. Danacıoğlu YO, Çolakoğlu Y, Yenice MG, et al. Comparison of two different grafts for the surgical treatment of Peyronie's disease. Andrologia. 2021;53(3):e13987. doi:10.1111/and.13987

9. Lue TF, El-Sakka AI. Venous patch graft for Peyronie's disease. Part I: technique. J Urol. 1998;160(6 Pt 1):2047–9. doi:10.1097/00005392-199812010-00029

10. Wagenknecht LV. Microsurgical arterialization for vascular impotence. Eur Urol. 1989;16(4):262–6. doi:10.1159/000471588

11. Wagenknecht LV. Microsurgical arterialization for vascular impotence. Microsurgery. 1988;9(4):258–61. doi:10.1002/micr.1920090410

12. Sohn M, Hatzinger M, Goldstein I, Krishnamurti S. Standard operating procedures for vascular surgery in erectile dysfunction: revascularization and venous procedures. J Sex Med. 2013;10(1):172–9. doi:10.1111/j.1743-6109.2012.02997.x

13. Dicks B, Bastuba M, Goldstein I. Penile revascularization — contemporary update. Asian J Androl. 2013;15(1):5–9. doi:10.1038/aja.2012.146

14. Manning M, Jünemann KP, Scheepe JR, et al. Long-term followup and selection criteria for penile revascularization in erectile failure. J Urol. 1998;160(5):1680–4.

15. Oertl AJ, Jonas D, Oremek GM, Jones J. Saphenous vein interposition as a salvage technique for complex vascular situations during renal transplantation. Transplant Proc. 2007;39(1):140–2. doi:10.1016/j.transproceed.2006.10.205

16. Shimizu T, Omoto K, Iida S, et al. Living related renal transplantation using a saphenous vein graft: a case report. Transplant Proc. 2018;50(8):2562–4. doi:10.1016/j.transproceed.2018.03.089

17. Alcocer F, Zazueta E, Montes de Oca J. The superficial femoral vein: a valuable conduit for a short renal vein in kidney transplantation. Transplant Proc. 2009;41(5):1963–5. doi:10.1016/j.transproceed.2009.02.098

18. Mikhalski D, Hoang AD, Bollens R, et al. Gonadal vein reconstruction for extension of the renal vein in living renal transplantation: two case reports. Transplant Proc. 2007;39(8):2681–4. doi:10.1016/j.transproceed.2007.08.088

19. Dalton JR. Practical management of venous injury during pelvic surgery for urologic disease. Urology. 1979;14(5):496–9. doi:10.1016/0090-4295(79)90183-3

20. Mulherin JL, Edwards WH. Alternative methods of renal revascularization. Ann Surg. 1987;205(6):740–6. doi:10.1097/00000658-198706000-00017

21. Bhalla V, Textor SC, Beckman JA, et al. Revascularization for renovascular disease: a scientific statement from the American Heart Association. Hypertension. 2022;79(8):e128–43. doi:10.1161/HYP.0000000000000217

22. Travis JA, Hansen KJ, Miller PR, Dean RH, Geary RL. Aneurysmal degeneration and late rupture of an aortorenal vein graft: case report, review of the literature, and implications for conduit selection. J Vasc Surg. 2000;32(3):612–5. doi:10.1067/mva.2000.108639

23. Younan EZ, Risbey CWG, Ye L, et al. Outcomes following inferior vena cava reconstruction at an advanced surgical unit. Eur J Surg Oncol. 2025;51(7):109740. doi:10.1016/j.ejso.2025.109740

24. Brown KG, Koh CE, Solomon MJ, Choy IC, Dubenec S. Spiral saphenous vein graft for major pelvic vessel reconstruction during exenteration surgery. Ann Vasc Surg. 2015;29(6):1323–6. doi:10.1016/j.avsg.2015.01.028

25. Gloviczki P, Pairolero PC, Cherry KJ, Hallett JW. Reconstruction of the vena cava and of its primary tributaries: a preliminary report. J Vasc Surg. 1990;11(3):373–81. doi:10.1067/mva.1990.16343

26. Kim BS, Kim HT, Kwon SY, et al. Nontransected ventral onlay-augmented urethroplasty using autologous saphenous vein graft in a rabbit model of urethral stricture. Urology. 2014;83(1):225–31. doi:10.1016/j.urology.2013.08.030

27. Wolters HH, Heistermann HP, Stöppeler S, et al. A new technique for ureteral defect lesion reconstruction using an autologous vein graft and a biodegradable endoluminal stent. J Urol. 2010;184(3):1197–203. doi:10.1016/j.juro.2010.04.072

28. Garland R, Frizelle FA, Dobbs BR, Singh H. A retrospective audit of long-term lower limb complications following leg vein harvesting for coronary artery bypass grafting. Eur J Cardiothorac Surg. 2003;23(6):950–5. doi:10.1016/s1010-7940(03)00116-7

29. Hassoun-Kheir N, Hasid I, Bozhko M, et al. Risk factors for limb surgical site infection following coronary artery bypass graft using open great saphenous vein harvesting: a retrospective cohort study. Interact Cardiovasc Thorac Surg. 2018;27(4):530–5. doi:10.1093/icvts/ivy137

30. Paletta CE, Huang DB, Fiore AC, et al. Major leg wound complications after saphenous vein harvest for coronary revascularization. Ann Thorac Surg. 2000;70(2):492–7. doi:10.1016/s0003-4975(00)01414-4

31. Crouch JD, O'Hair DP, Keuler JP, et al. Open versus endoscopic saphenous vein harvesting: wound complications and vein quality. Ann Thorac Surg. 1999;68(4):1513–6. doi:10.1016/s0003-4975(99)00947-9

32. Jeon MJ, Bai SW. Use of grafts in pelvic reconstructive surgery. Yonsei Med J. 2007;48(2):147–56. doi:10.3349/ymj.2007.48.2.147

33. Sung VW, Rogers RG, Schaffer JI, et al. Graft use in transvaginal pelvic organ prolapse repair: a systematic review. Obstet Gynecol. 2008;112(5):1131–42. doi:10.1097/AOG.0b013e3181898ba9