Invited commentary

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Muscular calf vein thrombosis (MCVT) is commonly seen in everyday practice, and as foam sclerotherapy gains dominance in treatment of venous disorders, this condition will become more prevalent. No treatment guidelines are available, so this study is important.

One hundred twenty-eight patients with 131 MCVTs were included in this study. Seventy-three (55.7%) had thrombosis of soleal veins, and 58 (44.3%) had thrombosis of the medial gastrocnemius veins. In our experience with foam sclerotherapy, the reverse incidence was seen.

Anticoagulation was prescribed (41.4%) for 1 month, 59 (46.1%) for 3 months, and 13 (10.2%) for 6 months or more. Nine patients (7%) had pulmonary emboli confirmed. We have had no suspected pulmonary emboli, but the incidence of MCTV in our foam sclerotherapy experience is only 0.003%. Six (10.3%) of the patients with thrombi were in the medial gastrocnemius vein group, and three (4.1%) were in the soleal vein group.

Recanalization of MCVT was complete at 1, 3, and 9 months in 54.8%, 84.7%, and 96% of cases, respectively. Our experience is similar except that venous reopening occurred much earlier. Perhaps this was because we administered low-molecular-weight heparin immediately when the diagnosis of MCTV was made.

This study confirms the importance of MCVT in venous thromboembolic disorders, but because this is an initial large report on this condition, the results should be confirmed by additional studies. There is a definite need to standardize the treatment of acute MCVT because no guidelines exist at this time.