Unilateral Soleus Hypertrophy in Case of Severe Varicose Veins

Background: Efficient transport of blood and lymph relies on competent intraluminal valves that ensure unidirectional fluid flow through the vessels. Dysfunction of venous valves is associated with venous hypertension, varicose veins, venous stasis, and thrombosis that can lead to edema and ulcerations. If valves in the perforator veins are incompetent, the high pressures generated in deep veins by calf-muscle contraction can be transmitted to the superficial system, and to the microcirculation in skin, creating ambulatory venous hypertension. In situations where varicose veins coexist with deep vein incompetence, our team postulates that the increased pressure in the superficial veins and perforator veins can lead to a compensation by the lower extremity musculature to overcome the pressure load, leading to hypertrophy of that musculature. Case Information: During routine dissection of a 67-year-old Caucasian female cadaver, a unilateral hypertrophied right soleus muscle was discovered. In the present case, this manifested with severe varicose veins on the same side of the cadaver as the hypertrophied right soleus muscle. Conclusions: Unilateral hypertrophy associated with varicose veins is sparsely recognized or reported and the association should be further explored. The practicing clinician should be aware of the possibility of unilateral calf muscle hypertrophy resulting from varicose veins when working up deep venous thrombosis or unilateral peripheral edema. Recognizing this association could help to prevent delay in diagnosis and reduce unnecessary testing. Various treatments for varicose veins are wide ranging and include compression stockings, sclerotherapy, venoactive drugs, thermal ablation, and surgical interventions.