Anatomical distribution of lower-extremity deep vein thrombosis and pulmonary embolism: a retrospective study with finite-element analysis of calf muscle-vein mechanics
- 1Department of Vascular Surgery, China-Japan Union Hospital of Jilin University
Abstract
Background: Muscular calf vein thrombosis is frequently detected by whole-leg ultrasonography, but its relationship with pulmonary embolism (PE) and the mechanical response of the intramuscular veins during calf-muscle contraction remain incompletely defined. We examined PE prevalence across anatomical categories of lower-extremity deep vein thrombosis (DVT) and used a structural finite-element model to quantify contraction-related venous compression and identify the regions in which deformation was greatest.
Methods: This retrospective study included patients evaluated for a first episode of lower-extremity DVT between May and October 2022. DVT was classified as isolated muscular calf vein thrombosis, isolated axial calf DVT, isolated proximal DVT, or combined muscular calf and proximal DVT. PE was diagnosed by computed tomography pulmonary angiography or pulmonary perfusion imaging. Because several cells contained few observations, the four-group distribution was compared using a Fisher-Freeman-Halton exact test. A separate finite-element analysis used one normal computed tomography angiography geometry. Gastrocnemius contraction, soleus contraction, and co-contraction were modeled as structural loading conditions. Spatial stress and strain maps were examined to localize venous regions with the greatest structural response. No blood-flow, venous-valve, or thrombus model was included.
Results: Among 160 patients with DVT, 30 had PE. PE was present in 14 of 125 patients with isolated muscular calf vein thrombosis [11.2%, exact 95% confidence interval (CI): 6.3%–18.1%], 1 of 4 with isolated axial calf DVT (25.0%, 95% CI: 0.6%–80.6%), 3 of 10 with isolated proximal DVT (30.0%, 95% CI: 6.7%–65.2%), and 12 of 21 with combined muscular calf and proximal DVT (57.1%, 95% CI: 34.0%–78.2%). The overall distribution differed across groups (exact p < 0.001). At the final recorded model-loading parameter, mean muscle von Mises stress was 21.51 kPa during gastrocnemius contraction, 1.16 kPa during soleus contraction, and 9.68 kPa during co-contraction. The corresponding changes in modeled venous-domain volume were −49.25, −17.07, and −64.08 mm ³ , respectively. The spatial maps showed nonuniform venous deformation, with the most prominent response concentrated around proximal branching regions and adjacent intramuscular venous segments.
Conclusions: PE prevalence differed across the anatomical DVT categories and was highest when muscular calf and proximal veins were involved concurrently. The structural model provided direct evidence that calf-muscle contraction compresses deep veins and localized the regions of greatest deformation. These findings support targeted dynamic venous imaging, while effects on blood flow and thrombus behavior require prospective patient-specific validation.
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BibTeX
@article{hong2026anatomical,
title = {{Anatomical distribution of lower-extremity deep vein thrombosis and pulmonary embolism: a retrospective study with finite-element analysis of calf muscle-vein mechanics}},
author = {Xin Hong and Jia Hou and Xingyu Hong},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1730081},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1730081/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Anatomical distribution of lower-extremity deep vein thrombosis and pulmonary embolism: a retrospective study with finite-element analysis of calf muscle-vein mechanics
AU - Xin Hong
AU - Jia Hou
AU - Xingyu Hong
PY - 2026
DA - 2026/10/14
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1730081
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1730081/full
AB - Background: Muscular calf vein thrombosis is frequently detected by whole-leg ultrasonography, but its relationship with pulmonary embolism (PE) and the mechanical response of the intramuscular veins during calf-muscle contraction remain incompletely defined. We examined PE prevalence across anatomical categories of lower-extremity deep vein thrombosis (DVT) and used a structural finite-element model to quantify contraction-related venous compression and identify the regions in which deformation was greatest. Methods: This retrospective study included patients evaluated for a first episode of lower-extremity DVT between May and October 2022. DVT was classified as isolated muscular calf vein thrombosis, isolated axial calf DVT, isolated proximal DVT, or combined muscular calf and proximal DVT. PE was diagnosed by computed tomography pulmonary angiography or pulmonary perfusion imaging. Because several cells contained few observations, the four-group distribution was compared using a Fisher-Freeman-Halton exact test. A separate finite-element analysis used one normal computed tomography angiography geometry. Gastrocnemius contraction, soleus contraction, and co-contraction were modeled as structural loading conditions. Spatial stress and strain maps were examined to localize venous regions with the greatest structural response. No blood-flow, venous-valve, or thrombus model was included. Results: Among 160 patients with DVT, 30 had PE. PE was present in 14 of 125 patients with isolated muscular calf vein thrombosis [11.2%, exact 95% confidence interval (CI): 6.3%–18.1%], 1 of 4 with isolated axial calf DVT (25.0%, 95% CI: 0.6%–80.6%), 3 of 10 with isolated proximal DVT (30.0%, 95% CI: 6.7%–65.2%), and 12 of 21 with combined muscular calf and proximal DVT (57.1%, 95% CI: 34.0%–78.2%). The overall distribution differed across groups (exact p < 0.001). At the final recorded model-loading parameter, mean muscle von Mises stress was 21.51 kPa during gastrocnemius contraction, 1.16 kPa during soleus contraction, and 9.68 kPa during co-contraction. The corresponding changes in modeled venous-domain volume were −49.25, −17.07, and −64.08 mm ³ , respectively. The spatial maps showed nonuniform venous deformation, with the most prominent response concentrated around proximal branching regions and adjacent intramuscular venous segments. Conclusions: PE prevalence differed across the anatomical DVT categories and was highest when muscular calf and proximal veins were involved concurrently. The structural model provided direct evidence that calf-muscle contraction compresses deep veins and localized the regions of greatest deformation. These findings support targeted dynamic venous imaging, while effects on blood flow and thrombus behavior require prospective patient-specific validation.
SN - 2297-055X
ER -