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Saphenous Vein Graft

The great saphenous vein can provide a tunical patch for Peyronie's surgery or a vascular conduit for selected reconstructive and transplant procedures. These applications have different indications and evidence; the material itself does not establish which operation a patient needs.[1][2]

See Grafts in GU Reconstruction for tissue-selection principles and Peyronie's disease for clinical assessment.

Why the Saphenous Vein for Genitourinary Reconstruction?​

Vein is autologous, pliable and available in variable lengths. Harvest adds a separate leg incision and can cause pain, sensory change, edema or wound problems. Autologous tissue avoids donor alloimmunity but remains vulnerable to infection, thrombosis, ischemic loss or remodeling according to the application. Two-team harvest is feasible when staffing and positioning permit; time savings cannot be assumed for every case.[4][31]

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

Grafting is an option for stable, functionally troublesome deformity with satisfactory baseline erectile function, particularly severe or complex curvature, hourglass/hinge deformity or concern about further shortening. An angle above 60 degrees alone is not a sufficient indication. Consider erectile function, response to medication, length, deformity and the patient's priorities; medically refractory ED generally shifts the discussion toward a penile prosthesis.[31][32]

The ICSM 2024 recommendations, published in 2025/2026, emphasize these selection principles and the risks of new ED and sensory change. The current EAU guideline does not identify a superior graft. Saphenous vein is one available autologous option; grafting does not guarantee restoration of pre-disease length or preservation of unaided erections.[31][32]

Outcome series​

StudyPopulation and follow-upFindings and limits
Montorsi 200050 selected men with normal preoperative erectile function; mean 32 monthsComplete straightening 80%, minor residual curvature 14%, significant recurrence 6%. Although rigidity was reported as preserved in 94%, 40% perceived slight shortening. This selected series does not predict outcomes in men with baseline ED.[5]
Yurkanin 200124 operated; 22 evaluable at follow-upMean measured length gain 2.1 cm. Intercourse was possible in 86%: 54% without aids and 32% with pharmacologic assistance; 14% had complete ED. A length average is not an individual promise.[6]
Austoni 2005145 received a soft prosthesis plus tunical incision and vein graft; mean follow-up 13 months, range 6 months–3 yearsMean lengthening approximately 1.5 cm. Of 80 questionnaire respondents, 76 were completely satisfied. The title's “5-year experience” describes the surgical experience, not five-year follow-up for all 145 patients. Outcomes cannot be attributed to the vein graft alone.[7]
Danacıoğlu 202141 men: vein 23, buccal mucosa 18; comparison through 12 monthsNo detected differences in reported functional/satisfaction outcomes; residual curvature 3/23 versus 2/18. This small nonrandomized comparison did not establish equivalence or noninferiority.[8]

Lue and El-Sakka described a vein-patch technique using relaxing tunical incisions and assembled vein segments. Technical descriptions and selected case series support feasibility, not a universal graft ranking.[9]

2. Penile Revascularization for Vasculogenic Erectile Dysfunction​

Historical operations used saphenous interposition between an arterial inflow source and penile vessels, including deep dorsal vein arterialization. These are not interchangeable with contemporary selective penile arterial reconstruction.[10][11][13]

The AUA ED guideline permits consideration of penile arterial reconstruction in young men with focal pelvic/penile arterial occlusion, without generalized vascular disease or veno-occlusive dysfunction (conditional recommendation, Grade C). Careful specialist evaluation and counseling about uncertain long-term benefit are essential. The older 2013 “Grade D” statement and a rigid age-55 cutoff are not the current AUA recommendation. Penile venous surgery for ED is not recommended.[12][33]

For context, Manning's historical 62-patient revascularization series reported satisfactory spontaneous erections in 34% and a further 20% with pharmacologic support at mean 41 months. Combining these categories into an unaided “cure” rate would be misleading.[14]

3. Vascular Salvage During Kidney Transplantation​

Vein can extend or reconstruct a short or damaged transplant vessel, with configuration determined by length, caliber, flow and available alternative conduits. Evidence for specific saphenous configurations is largely technical reports and small series.[15][16]

  • Short renal vein: Shimizu's single case used a 15-cm harvested saphenous segment to construct an approximately 1-cm extension. A 1-cm extension should not be mistaken for a 1-cm harvest.[16]
  • Arterial salvage: Oertl describes selected complex vascular situations within a 100-transplant experience; the abstract does not establish 100 recipients of saphenous interposition.[15]
  • Alternatives: gonadal or femoral vein reconstructions have been described. Their differing donor morbidity and size do not justify treating the options as interchangeable.[17][18]

4. Intraoperative Pelvic Venous-Injury Repair​

Saphenous vein can supply a patch or interposition graft when a major pelvic vein cannot be repaired primarily. Dalton's report describes this reconstructive option; it does not support managing major vascular injury without appropriate vascular assistance. Obtain hemorrhage control and specialist support, then select the repair for the defect and physiology. Leg harvest requires separate preparation and exposure.[19]

5. Aortorenal Bypass for Renovascular Disease​

The AHA scientific statement emphasizes that routine revascularization for atherosclerotic renal artery disease has not improved outcomes over optimal medical therapy in the major randomized trials. Selected high-risk syndromes or complex anatomy may justify referral; the availability of a vein conduit is not itself an indication.[2]

Open reconstruction is reserved for selected situations such as failed endovascular treatment, complex branch disease or concomitant aortic surgery. Saphenous vein is one conduit alongside arterial autograft and synthetic material. In children and young adults, concern about late vein-graft aneurysmal degeneration may favor hypogastric artery when feasible. The statement does not designate vein as the preferred conduit for every adult.[2][20] Late aneurysmal degeneration and rupture have been reported; reassuring renal flow characteristics do not eliminate long-term conduit surveillance.[21]

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

Patch repair, primary closure and interposition grafting address different defects. A 2025 two-center cohort used bovine pericardium in 61 of 71 IVC reconstructions (86%); this describes those centers, not worldwide graft use or comparative superiority.[22]

A spiral saphenous graft can be fashioned to match a larger iliac vessel. Brown describes this option during exenteration, where contamination can influence selection of autologous rather than synthetic material. Its trade-offs and infection risk still require assessment; a technical report cannot establish universal preference.[23] Gloviczki's historical preference for spiral vein concerned the superior vena cava; the same report favored PTFE for abdominal IVC replacement. Do not transfer the SVC conclusion to the IVC.[24]

7. Experimental — Urethral and Ureteral Reconstruction​

The cited animal studies demonstrate feasibility, not routine human indications:

  • Saphenous urethral onlay: Kim randomized ten rabbits with induced stricture to grafting or no repair, with five additional normal controls. Grafts were urothelialized at 12 weeks. The graft group contained five animals.[25]
  • Vein ureteral substitute: Wolters used external jugular vein, not saphenous vein, in pigs with a 3-cm ureteral defect, with/without a biodegradable stent. Six-month findings are preclinical and cannot establish saphenous substitution as a clinical standard.[26]

Donor-Site Morbidity​

Counsel about leg wound infection/dehiscence, pain, altered sensation and swelling. Most numerical estimates in the original literature come from coronary bypass populations with different harvest lengths, vascular risk and perioperative care; they should not be presented as the expected rates after short GU harvest.[4][27][28]

Endoscopic harvest reduced wound problems in cardiac comparisons, including Crouch's series. That finding does not establish a universal requirement or the same absolute risk reduction for urologic harvest. Select the technique for required tissue, donor condition and local expertise.[29]

Summary of Applications​

ApplicationPlace of vein grafting
Peyronie's tunical reconstructionAvailable autologous option after appropriate surgical selection; no proven best graft
Penile arterial reconstructionHighly selected specialist surgery; historical vein arterialization is distinct
Transplant or pelvic vascular salvageDefect-specific patch or conduit; largely technical-series evidence
Aortorenal bypassSelected renovascular indications; conduit choice is individualized
IVC / iliac reconstructionPossible patch or spiral conduit; no universal superiority
Urethral / ureteral substitutionThe cited evidence is animal work; the pig ureteral donor was jugular vein

No Established Role in Urogynecology​

Saphenous vein is not an established structural graft for routine prolapse or continence surgery. Older reviews of pelvic grafts should not be used to imply that all synthetic or biologic materials described historically remain recommended or available for every route and indication. Use the relevant contemporary condition and procedure pages for those decisions.[3][30]

Key Takeaways​

Select the indication before the material. Discuss postoperative ED and length uncertainty before Peyronie's grafting; request vascular expertise for major vessel reconstruction; and describe donor morbidity without importing cardiac harvest percentages into GU counseling.

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. PubMed.

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. PubMed.

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. PubMed.

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. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. Chung E, Ziegelmann M, Lin HC, et al. Management of Peyronie's disease: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024). Sex Med Rev. 2026;14(1):qeaf068. Published online December 2025. doi:10.1093/sxmrev/qeaf068.

32. European Association of Urology. Sexual and Reproductive Health, 2026. Penile curvature: surgical treatment and graft selection. Guideline.

33. Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200:633–641. doi:10.1016/j.juro.2018.05.004. Statements 21–22.