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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. Procedure selection depends on indication, and evidence differs between applications.[1][2]

A selective venous use is a patch or cuff to enlarge a narrow left renal vein during transposition for severe, established nutcracker syndrome. ESVS 2025 describes this adjunct when needed; its recommendation to consider transposition is Class IIa, Level C.[38]

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. During calf harvest, identify and protect saphenous-nerve branches where they cross or adhere to the vein; distal nerve–vein adherence occurred in 32/37 (86%) cadaveric limbs.[37] 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; potential time savings depend on the 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 online in December 2025 and in print in 2026, emphasize individualized selection; the EAU guideline describes new ED and penile numbness as risks of grafting.[31][32] For tunical lengthening across graft materials, EAU 2026 advises counseling men without preoperative ED about postoperative ED risk of up to 50%.[32] The current EAU guideline does not identify a superior graft.[31][32] Saphenous vein is one available autologous option.[31][32]

Outcome series​

StudyPopulation and follow-upFindings and limits
Montorsi 200050 selected men with normal preoperative erectile function; 6 also underwent plication; mean 32 monthsComplete straightening 80%, minor residual curvature 14%, significant recurrence 6%. Although rigidity was reported as preserved in 94%, 40% perceived slight shortening.[5]
Yurkanin 200124 operated; 22 evaluable at follow-upMean erect penile length gain 2.1 cm. Intercourse was possible in 86%: 54% without aids and 32% with pharmacologic assistance; 14% had complete ED.[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. At 12 months, 76 of 80 telephone-questionnaire respondents were completely satisfied.[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.[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. Wagenknecht interposed a saphenous graft between the iliac artery and the deep dorsal penile vein in 15 men with internal pudendal occlusion; two thirds were doing well at two years, and the five failures included four diabetic neurovascular lesions and one postoperative priapism.[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 .[33] Careful specialist evaluation and counseling about uncertain long-term benefit are needed. For young men considered for revascularization after pelvic or perineal trauma, the EAU guideline specifies penile pharmaco-arteriography to confirm arterial stenosis and dynamic infusion cavernosometry or cavernosography to exclude corporeal veno-occlusive dysfunction, a contraindication.[34] The older 2013 “Grade D” statement and a rigid age-55 cutoff are not the current AUA recommendation.[33] Penile venous surgery for ED is not recommended.[12][33]

For context, Manning's historical 62-patient series combined 7 Virag, 13 Hauri and 42 Mannheim triple-anastomosis revascularization procedures; pooled results showed spontaneous erections in 34% and pharmacologically induced erections in another 20% at mean 41 months, without isolating outcomes for saphenous-vein interposition.[14] 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.[16]
  • Arterial salvage: Oertl describes selected complex vascular situations within a 100-transplant experience.[15]
  • Alternatives: gonadal or femoral vein reconstructions have been described.[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 describes repair choices, including venous patch and replacement grafts, for a urologist facing major pelvic venous injury when no vascular surgeon is available. 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.[2] Selected high-risk syndromes or complex anatomy may justify referral.[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.[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.[22] A 2025 two-center cohort used bovine pericardium in 61 of 71 IVC reconstructions (86%).[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.[23] Gloviczki's historical preference for spiral vein concerned the superior vena cava; the same report favored PTFE for abdominal IVC replacement.[24]

7. Urethral Vein Grafts and Experimental Ureteral Substitution​

Small human series describe everted great-saphenous-vein dorsolateral onlay for long anterior urethral stricture, including men with tobacco-exposed oral mucosa. In a 17-patient series, the harvested vein was hydro-distended, opened and everted; two patients required endodilatation and one had complete failure at mean 17.64-month follow-up.[35] A nonrandomized comparison from the same center enrolled 15 vein recipients with tobacco-exposed oral mucosa and 15 oral-mucosa graft recipients with healthy oral mucosa; after at least 18 months of follow-up, 11/14 evaluable vein recipients met a composite of Qmax >15 mL/s and no endoscopic retreatment.[36]

The cited animal studies demonstrate feasibility:

  • Saphenous urethral onlay: Kim randomized ten rabbits with induced stricture to grafting or no repair, with five additional normal controls. The graft group contained five animals. Mean operated urethral width at two weeks was 10.04 mm in the graft group, 4.3 mm in the untreated stricture group and 10.2 mm in controls, and the neourethra was lined with urothelium at 12 weeks without fistula or infection.[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.[26] The pigs were followed for six months.[26]

Donor-Site Morbidity​

Counsel about leg wound infection/dehiscence, pain, altered sensation and swelling.[4][27][28] Most numerical estimates come from coronary bypass populations with different harvest lengths, vascular risk and perioperative care.[4][27][28]

Complication after leg vein harvest for coronary bypassReported frequency
Numbness or tingling256/422 (61%) in a questionnaire audit; 41% of those affected still had it beyond 2 years[4]
Wound pain193/422 (46%); 10% of those affected still had pain beyond 2 years[4]
Leg wound infection126 respondents in a questionnaire audit (the paper gives conflicting percentages)[4]; 36/351 (10.3%) in a retrospective open-harvest cohort with 90-day follow-up[27]
Unilateral leg swelling175/422 (41%); 23% of those affected still had swelling beyond 2 years[4]
Any lower-extremity wound complication145/3,525 (4.1%), with 23 (0.65%) needing surgical intervention[28]

Independent risk factors for leg surgical site infection in the open-harvest cohort were female sex (OR 4.08), body mass index above 30 (OR 2.12) and peripheral vascular disease (OR 3.33).[27] Median time to detection was 14 days, and 25/36 (69%) infections were diagnosed after discharge.[27]

In a retrospective cardiac-bypass comparison, endoscopic harvest was associated with fewer wound complications than open harvest.[29] In Crouch's series, wound complications occurred in 9/180 (5%) endoscopic and 55/388 (14.2%) open harvests; no histologic difference was found in vein segments from only eight patients (four per group).[29] Urologic absolute risk reduction was not assessed. 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 substitutionSmall human series describe everted saphenous urethral onlays[35][36]; the cited ureteral substitute remains pig work using jugular vein[26]

No Established Role in Urogynecology​

Saphenous vein is not an established structural graft for routine prolapse or continence surgery. 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. doi:10.1097/00005392-200006000-00017

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. doi:10.1097/00005392-200111000-00035

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:10.1016/S0022-5347(01)62239-0

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. doi:10.1016/s0022-5347(01)62382-6

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. Guidelines on Sexual and Reproductive Health, Limited Update March 2026, section 8.2.3.b (surgical treatment of Peyronie's disease 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.

34. European Association of Urology. Guidelines on Sexual and Reproductive Health, Limited Update March 2026, section 5.6.11.a (surgery for post-traumatic arteriogenic erectile dysfunction). Guideline.

35. Akhtar A, Khattar N, Goel H, Rao S, Tanwar R, Sood R. "Looking beyond oral mucosa: Initial results of everted saphenous vein graft urethroplasty (eSVGU) in long anterior urethral strictures." Arab J Urol. 2017;15(3):228–235. doi:10.1016/j.aju.2017.06.003

36. Rao SN, Khattar N, Akhtar A, Goel H, Varshney A, Sood R. "Everted saphenous vein graft for long anterior urethral strictures in men with tobacco-exposed oral mucosa: A prospective nonrandomized study." Indian J Urol. 2019;35(2):134–140. doi:10.4103/iju.IJU_352_18

37. Wilmot VV, Evans DJR. "Categorizing the distribution of the saphenous nerve in relation to the great saphenous vein." Clin Anat. 2013;26(4):531–536. doi:10.1002/ca.22168

38. Koelemay MJ, Geelkerken RH, Kärkkäinen J, et al. "Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins." Eur J Vasc Endovasc Surg. 2025;70(2):153–218. doi:10.1016/j.ejvs.2025.06.010