The gastrocnemius muscle veins drain via two stem veins (medial and lateral) into the popliteal vein at the same level as the lesser saphenous vein. The soleus muscle veins perforate the inner fascia at two to four different levels and connect to the posterior tibial or peroneal veins. Two groups exist: the gastrocnemius and the soleus muscle veins. KeywordsĪ distinct anatomic entity is formed by the calf muscle veins. Specifically designed and adequately powered clinical studies addressing the issue of IDDVT need to be urgently undertaken. It also seems likely that different approaches may be better for unprovoked or secondary events and for deep or muscle veins. There is, however, insufficient data to support the diagnosis and treatment of all IDDVTs, and the necessary criteria to identify subjects at higher risk of complication are lacking. Guidelines recommend anticoagulation for 12 weeks, although 6 weeks may be sufficient. Optimal treatment of IDDVT is still controversial. A series of studies has shown, however, that a single complete ultrasound strategy in symptomatic patients has comparable clinical results to serial proximal ultrasound, allowing approximately 15% better DVT diagnosis. Diagnosis of IDDVT is based on ultrasound examination of all calf veins, which is more operator‐dependent and less sensitive than proximal vein examination. IDDVTs are associated with (i) lower risk of recurrence when compared with other VTEs, and (ii) fewer late sequelae than proximal DVT. Due to discordant results, the real risk of IDDVT‐associated PE is not well established.

Conflicting clinical results have resulted in differing opinions on the need to test for IDDVTs and how to treat them.

Despite their frequency, IDDVTs still remain one of the most debated issues in the field of venous thromboembolism (VTE). Thromboses that are restricted to the infra‐popliteal deep veins of the lower limbs (isolated distal deep vein thrombosis, IDDVT) are frequently diagnosed in subjects with suspected pulmonary embolism (PE 7–10%) or DVT (4–15%), accounting for 31–56% of all diagnosed leg DVTs.

Peroneal vein deep vein thrombosis