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I appreciate the valuable comments by Dr Kahn. Isolated calf thrombosis of the soleal or gastrocnemial muscle veins has been known for over 30 years.¹ A sonographic study retrospectively investigating thrombus distribution in clinically suspected DVT showed ICMVT in 37% of sonographically proven symptomatic calf thromboses.² The results of our study on flight-associated thrombosis indicate that the incidence of (asymptomatic) ICMVT is about 100 times higher than the incidence of (symptomatic) DVT.³ This finding raises the obvious question of the clinical relevance of these small calf clots.

In general, availability of published data on ICMVT is scarce. In consequence, the findings of MacDonald et al⁴ contribute to a better understanding regarding the natural history of ICMVT. Unfortunately, the investigators could complete the 3-month follow-up in only 65% of the included patients. Furthermore, in this study, the mortality during the follow-up was very high (12%). The incidence of death . . . [Full Text of this Article]

Thomas Schwarz, MD

Correspondence: Dr Schwarz, Department of Internal Medicine III, Division of Vascular Medicine, University of Dresden Medical School, Fetscherstrasse 74, 01307 Dresden, Germany (tho_schwarz@hotmail.com).

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