Examination of the muscular-venous network of the calf allows
a better understanding of venous disease, as this constitutes
the site of intimate relationships which involve the five components
of venous hemodynamics: intravenous pressure, venous wall, valves,
perivenous muscle, and muscle fascia. Clearly functional anatomy
is particularly important in this context.
The calf is a large muscle mass made up of the triceps surae
muscle, composed of two planes: a superficial plane, comprising
the medial and lateral heads of the gastrocnemius muscle: and
a deep plane, corresponding to the soleus muscle. These muscles,
inserted in the distal part of the femur, fuse inferiorly to
form the tendo calcaneus.
Le mollet représente une importante masse musculaire correspondant au
muscle triceps sural. Celui-ci comporte deux plans : l'un superficiel, les
muscles jumeaux interne et externe, l'autre profond, le muscle soléaire.
Issus de la partie distale du fémur, ces muscles se rejoignent en bas
pour former le tendon d'Achille.
The gastrocnemius veins
are situated within the medial and
lateral gastrocnemius muscles (Figure 73
Lateral gastrocnemius veins have a much smaller caliber than
medial gastrocnemius veins. A dense intramuscular venous plexus
unites to form a common extramuscular trunk which travels for
I to 4 cm in the loose adipose connective tissue of the popliteal
This common extramuscular trunk of the gastrocnemius muscle
• directly in the popliteal vein, very obliquely, forming
an acute angle, almost vertically above the popliteal vein;
this allows the gastrocnemius veins to ensure a shock-absorbing
role in the case of sudden pressure variations in the popliteal
• in the saphenopopliteal junction at the level of the
concavity of the short saphenous vein: this type of termination
makes saphenopopliteal junction ligation flush with the popliteal
vein more difficult; or
• simultaneously in the popliteal vein and short saphenous vein via a lambda-shaped termination.
In the popliteal fossa, the gastrocnemius veins and short saphenous
veins have a different macroscopic appearance. The gastrocnemius
veins are bluish and have a fine, poorly muscular, but highly
elastic wall. In contrast. the short saphenous vein, situated
more superficially, retains the pearly appearance of veins of
the subcutaneous plexus.
The intramuscular gastrocnemius veins form a dense venous plexus,
which branches and anastomoses within the mass of muscle tissue
In the lower part of the calf, one of the largest branches
emerges from the medial gastrocnemius muscle, where the muscle
mass gives way to membranous tissue, this constitutes the
gastrocnemius perforating vein or Gillot's lower pole perforating
93 et 100).
The soleus veins are situated in a deeper muscle plane.
They unite to form one or several main trunks, which terminate
in either the posterior tibia vein or the peroneal vein. In
contrast with the gastrocnemius veins, their extramuscular
portion is very short. However. like the gastrocnemius veins,
they receive a perforating vein at the lower pole of the muscle,
which communicates with the gastrocnemius venous plexus or
directly with the short saphenous superficial network.
The general arrangement of the intramuscular plexus of soleus
veins is variable. It can be predominantly vertical and terminate
via a single common trunk in the posterior tibial or peroneal
network, or it can be predominantly horizontal and comprise
an anastomosis with the posterior tibial or peroneal network
via multiple intramuscular arches at different levels.
Daniel C. Le syndrome des veines jumelles. Actualité Vasculaire Internationale,
1992; 6 : 16-22.
Gillot C. La perforante polaire inférieure du muscle jumeau interne.
Phlébologie, Édition Médicale Média Internationale,
Congrès de Bruxelles, vol 1, 1983.
Thierry L. Physiology of the muscular veins. Phlébologie, Éditions
John Libbey Eurotext, Montréal 1992.
Van der Stricht J. Staelens I. Les veines musculaires du mollet. Phlébologie
1994; 47, 2: 135-43.