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The anatomy of the gastrocnemius veins and trunks in adult human cadavers
(Portuguese PDF version)

José Aderval Aragão,¹ Francisco Prado Reis,² Luis Francisco Poli de Figueiredo,³ Guilherme Benjamin Brandão Pitta,⁴ Fausto Miranda Jr.5

1. Assistant Professor of Anatomy, Universidade Tiradentes, Aracaju, SE, Brazil.

2. Full Professor of Anatomy, Universidade Tiradentes, Aracaju, SE, Brazil.

3. Chairman, Operative Techniques and Experimental Surgery, Department of Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

4. Associate Professor of Surgical Clinics, Universidade de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL, Brazil.

5. Associate Professor of Surgical Clinics, Universidade de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL, Brazil.

Correspondence:
José Aderval Aragão
Rua Aloísio Campos 500, Atalaia
CEP 49035-020 - Aracaju, SE, Brazil
Phone: +55 (79) 255.1381
E-mail: jaafelipe@infonet.com.br

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ABSTRACT

Objective: The objective of the present paper was to carry out an anatomic study of the gastrocnemial veins in adult human cadavers by dissection.

Method: This study was made with 20 human adult cadavers, all male, fixed and maintained in 10% formaldehyde solutions. All gastrocnemial veins were dissected from their emerging of the heads of the gastrocnemius muscle to the place of drainage. In order to take the measurements, a digital pachymeter was used. Descriptive statistics were used for the variables of the study.

Results: In 80 dissected gastrocnemius muscle heads 438 gastrocnemial veins were found, 233 of which on the right leg and 205 on the left leg. 95 main trunks were identified, 51 of which on the right leg and 44 on the left leg. The variation extension of these trunks was of 0.5 cm to 7.8 cm with a whole remarkable extending observations of 7.3 cm. Of the total of the main gastrocnemial trunks 83 end in the popliteal vein and 12 in other veins.

Conclusions: The right leg showed a higher number of these veins than the left leg. The average of length of the gastrocnemial trunks was similar on both legs. Most of the gastrocnemial trunks emerge into the popliteal vein.

Key words: veins, anatomy, leg.

J Vasc Br 2004;3(4):297-303

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In general, anatomy text-books do not approach the gastrocnemius veins anatomy,^1-13 most of them refer to the connection of these veins with the popliteal vein.^14-15 The gastrocnemius veins are described as long,¹⁵ single⁶ or double, and^16-17 according to Vilallonga et al.,¹⁸ they drain into the posterior tibial veins.

Different authors^19-22 referred to the termination of the small saphenous vein in the gastrocnemius muscle veins. In 1989, Vandendriessche²² highlighted that the saphenopopliteal and the gastrocnemius-popliteal veins have common terminations.

According to the literature, the number of gastrocnemius veins would be from two to four²³ and from four to six.²⁴ Hobbs²⁴ also believes the veins form double trunks in the medial head of the gastrocnemius muscle and a single trunk in the lateral head of this muscle. Sherman²⁵ and Gillot²⁶ claimed that the muscular perforating veins were likely to be gastrocnemius veins.

The importance of gastrocnemius veins has been widely acknowledged by physicians and surgeons.^27-30 However, despite not being described in important anatomy manuals, a few studies have been carried out on their anatomy. The present study was designed to describe the main anatomic variations of these vessels in order to try to fill the gap between the high importance of these veins and the lack of knowledge on the subject.

MATERIAL AND METHODS

Forty lower limbs in 20 human adult cadavers were selected for this study; all male and fixed for more than a year in 10% formaldehyde solution. The corpses were supplied by anatomy labs of the following universities: Universidade Federal do Sergipe, Universidade Tiradentes, Universidade Federal da Bahia and Universidade de Ciências da Saúde de Alagoas. The material was according to the Brazilian Law 8501 dated 11/30/92, which provides for the use of cadavers for scientific study and research purposes. It was also approved by the ethical committees of UNCISAL and UNIFESP.

Cadavers with pathological and macroscopically observed alterations in the lower limbs were excluded from the study. The gastrocnemius muscle heads were our object of observation. After dissection of the leg's anatomic plans, we gained access to the popliteal fossa and dissected all gastrocnemius veins carefully and thoroughly, without the help of optical devices, from the muscle head up to their termination. All veins were counted and a description of their distribution in the leg and head of the gastrocnemius muscle was performed. With the aid of a digital pachymeter, the extension of the main gastrocnemius trunk was measured. The findings of the anatomic dissection were documented in digital images and demonstrative tables with data about variations in veins and gastrocnemius trunks dissected.

RESULTS

We identified 438 gastrocnemius veins in the 80 heads of 40 gastrocnemius muscles studied. A higher number of veins was found in the right leg's gastrocnemius (Table 1). The number of veins per muscle head ranged from two to 12, the right leg presenting the higher variation. It is worth mentioning the right leg presented less veins in the medial muscle head and higher variation in the total of veins of the lateral head.

Table 1 - Descriptive statistical analysis of volumetry measures (ml) at two
different moments

Period	Limb	Mean	Mean standard deviation	Minimal volumetry	Maximal volumetry
Morning	Right	3,371.8	87.1	2,360	4,400
	Left	3,345.4	88.1	2,200	4,390
Evening	Right	3,454.3	90.8	2,365	4,570
	Left	3,405.7	90.4	2,320	4,460

The trunks of the gastrocnemius muscle corresponded anatomically to venous segments draining into the gastrocnemius veins or smaller trunks. All trunks joined in one segment which was the final portion of the gastrocnemius venous drainage. The smaller trunks, named collateral ended in axial trunks, which drained into the main trunk, responsible for receiving all the venous drainage of the gastrocnemius muscle (Figure 1).

Figure 1 - Posterior view of the inferior limb showing the gastrocnemius trunks

We identified 221 trunks in the 80 heads of the gastrocnemius muscles studied. 95 were found to be main trunks, 81 axial and 45 collateral. The right leg had the highest number of main trunks, which were most frequent in the medial heads (Table 2). Double main trunks were found in 17 gastrocnemius heads (Figure 2), being present in 11 heads of the right leg, most frequently in the medial heads. There were two cases of absent main trunk in the gastrocnemius muscle: one in the medial head and other in the lateral head of the muscle, both in the left leg (Figure 3).

Table 2 - Statistical analysis of differences in the volumetric measures

Limb	Means difference	Standard error of means difference	Standard deviations of differences standard	95% CI lower limit	95% CI upper limit	P
Right	82.5	11.7	61.9	58.4	106.5	< 0.001*
Left	60.3	13.5	71.8	32.4	88.5	< 0.001*

CI = confidence interval

Figure 2 - Posterior view of the inferior limb showing a double gastrocnemius trunk

Figure 3 - Variation of CSFP in Groups I (dotted line), II (dashed line), and III (continuous line) during the experiment.

The extension of the main trunk in the muscle head had an expressive length in the sample (7.3 cm). Extreme values were found in the lateral head of the right leg muscle and in the medial head of the left leg, but this variation had no statistical significance in the Student test (Table 3).

Table 3 - Descriptive statistics of circumference measurements (cm) at two different
moments

Region	Period	Limb	Mean	Mean Standard error	Minimal circumference	Maximal circumference
Calf	Morning	Right	35.7	0.6	29.5	41.5
		Left	35.5	0.6	29.3	42
	Evening	Right	36	0.6	29	42.5
		Left	35.6	0.6	29	42
Ankle	Morning	Right	22.9	0.4	19.5	26.5
		Left	22.9	0.4	20	27
	Evening	Right	23.1	0.4	20	26.9
		Left	23	0.4	20	27.3

Eighty-three out of 95 trunks studied (87.37%) ended in the popliteal vein (Figure 4), and 12 (12.63%) were distributed into the following veins: common posterior tibial, common fibular, tibiofibular, solear, small saphenous (Figure 5), and into another trunk of the main gastrocnemius trunk (Table 4). Due to the high frequency and the interest in the anatomic features of these vessels, we also observed the topography of the main gastrocnemius trunk terminations with respect to the fascias of the popliteal vein walls (Table 5). From the 83 main trunks that ended in the popliteal vein, 44 were from the right leg and 39 from the left, being slightly predominant in the right leg and in the medial head of both legs. Twenty-two main trunks of the gastrocnemius muscle ended in the medial, lateral or anterior fascias of the popliteal veins, and 17 in the posterior. The termination of the gastrocnemius trunk in the medial fascia of the popliteal vein was predominant in the medial heads and in the lateral fascia of the lateral heads.

Table 4 - Statistical analysis of differences in the circumference measurements
in the calf region

				CI 95%
Limb	Differences	Mean difference	Standard error of mean difference	Lower limit	Upper limit	P
	Evening-
Right	morning	0.328	0.131	0.058	0.597	0.019 *
Left	Evening-	0.131	0.126	-0.127	0.389	0.308
	morning

CI = confidence interval

Table 5 - Statistical analysis of ankle region measurement differences

				CI 95%
Limb	Differences	Mean difference	Standard error of mean difference	Lower limit	Upper limit	P
	Evening-
Right	morning	0.183	0.120	-0.062	0.428	0.138
Left	Evening-	0.048	0.128	-0.215	0.311	0.710
	morning

CI = confidence interval

Figure 4 - Posterior view of the inferior limb showing the main gastrocnemius trunk draining into the popliteal vein

Figure 5 - Posterior view of the inferior limb showing the main gastrocnemius trunk draining into the small saphenous vein

DISCUSSION

The present study revealed that the number of veins in the gastrocnemius muscle may vary from two to 12, diversely from other studies,^{14,15,17,23,31} in which a variation of one to six veins is reported. Differences may be because these studies did not make anatomic dissections as the ones carried out in the present work.

Many different authors^{14,15,22,24,27,31-33} have described that a vein would be responsible for the venous drainage of the gastrocnemius muscle, generally ending in the popliteal vein. This vein, named main gastrocnemius trunk, was double in 17 gastrocnemius muscle heads and absent in two, out of a total of 80 dissected heads. Double main trunks were most frequent in the right leg, predominantly in the medial head. The main gastrocnemius trunk was described as a long vein, although neither mean nor absolute values have been mentioned.^15,22,34 According to Vandendriessche,²² the gastrocnemius vein was two to three cm long. These values are similar to the mean values we found in the present study, which varied from 1.64 to 2.30 cm. The mean longest and shortest extension of the main gastrocnemius trunk occurred in the medial head and in the lateral head of the right leg, respectively.

Different authors describe the termination of the main gastrocnemius trunk as being the popliteal veins.^{14,16,22-24,27,34,35} In our findings, 83 out of 95 trunks had this configuration, and 12 did not. The topography of the main gastrocnemius trunks drainage in the popliteal vein fascia indicate the lack of data on the topic, not frequently cited in the literature.

Anatomic knowledge about these veins, as well as their physiology and physiopathology, are fundamental for the understanding of some venous diseases, as for example, understanding the mechanisms of venous return, either healthy or impaired. Some authors have claimed that knowledge on the anatomy of the gastrocnemius veins may allow a better understanding of calf venous thrombosis, recurrence of varicose veins, and chronic venous insufficiency. Today, invasive and non-invasive methods have been used in the diagnosis and assessment of the venous system, especially by Doppler ultrasound and phlebography. The exact notion of the anatomy of the gastrocnemius muscle veins is considered to be fundamental in this scenario.

CONCLUSIONS

We observed that the number of gastrocnemius veins varied as for the leg and gastrocnemius muscle head. The end of the venous drainage of this muscle corresponded to a main gastrocnemius trunk which ended mostly in the popliteal vein. The presence of the main trunks varied according to leg and head of the gastrocnemius muscle, which ended mostly in the medial, lateral and anterior fascias of the popliteal vein. The values of the main trunks length did not show to be statistically significant with relation to legs and head of the gastrocnemius muscle.

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