The saphenous hiatus (saphenous opening) is an oval defect in the fascia lata in the anterior upper thigh through which the great saphenous vein passes to join the femoral vein. It is covered by the cribriform fascia, which is pierced by the saphenous vein, lymphatic vessels, and small superficial arteries.
The saphenous hiatus is the landmark for the saphenofemoral junction (SFJ) in varicose vein surgery and endovenous ablation. The SFJ lies 3-4 cm below and lateral to the pubic tubercle. Incompetence at the SFJ is the most common cause of great saphenous varicosities. The hiatus is also the site where a saphena varix presents as a femoral swelling with a cough impulse.
Reflux at the saphenous hiatus causing great saphenous varicosities, detected by duplex ultrasound showing reversed flow at the SFJ during Valsalva, treated by high ligation, stripping, or endovenous ablation.
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