Anatomical consideration of deep calf veins: application to catheter-directed thrombolysis

Purpose An antegrade approach is frequently used in catheter-directed thrombolysis to remove deep-vein thrombosis. However, the antegrade approach is difficult when accessing veins with small diameters; therefore, understanding the variation of deep calf vein is important. Methods This study measured the diameters and surface areas of the proximal and distal posterior tibial vein, peroneal vein, and anterior tibial vein to determine which are preferable for venous access. This study dissected 132 legs from Korean and Thai cadavers. The proximal and distal posterior tibial vein, peroneal vein, and anterior tibial vein were scanned and measured. Results The mean diameter and surface area were largest for the proximal tibial vein, at 6.34 mm and 0.312 cm(2), respectively, followed by the anterior tibial vein (5.22 mm and 0.213 cm(2)), distal posterior tibial vein (3.29 mm and 0.091 cm(2)), and peroneal vein (3.43 mm and 0.081 cm(2)). The proximal posterior tibial vein and anterior tibial vein have large diameters and surface areas, which make them ideal for applying an antegrade approach in catheter-directed thrombolysis. Conclusions The distal posterior tibial vein and peroneal vein are not recommended due to their smaller surface areas and also the anatomical variations therein.