The popliteal vein is the deep vein of the popliteal region, the direct continuation of the posterior tibial vein draining the leg into the femoral vein. Deep vein thrombosis involving the popliteal vein or more proximally carries a significant pulmonary embolism risk because the large vein diameter allows large thrombus formation and proximal propagation. DVT isolated to the popliteal vein or more proximally is the threshold above which anticoagulation is universally recommended.
| Origin | Junction of the anterior and posterior tibial veins at the lower popliteal fossa |
|---|---|
| Course | Formed at the lower border of popliteus, ascends through the popliteal fossa superficial to the popliteal artery (medial to it below, crossing to its lateral side above), and passes through the adductor hiatus to become the femoral vein |
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Popliteal vein DVT produces calf swelling, tenderness and warmth; Homan sign is unreliable, and compression duplex ultrasound at the popliteal level is the key test. Thrombosis at or above the popliteal vein carries a much higher pulmonary embolism risk than isolated calf vein DVT, and knee arthroplasty is a major risk factor, so thromboprophylaxis is standard. The vein can be compressed by a popliteal artery aneurysm, a Baker cyst or tight bracing, and in young athletes by popliteal vein entrapment. The level of the saphenopopliteal junction varies widely, so it is mapped by duplex ultrasound before treating small saphenous varicose veins.
Deep vein thrombosis at or above the popliteal vein, common after knee replacement, needs anticoagulation (usually for at least three months) to prevent pulmonary embolism.
Valve failure where the small saphenous vein joins the popliteal vein causes varicose veins of the back of the calf, mapped by duplex ultrasound and treated by endovenous ablation or surgical ligation.
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