Bill Johnson, Port Townsend, WA

To answer your first question, I have not seen an AV fistula from any EVLA
procedure, although they can result from any invasive procedure.  They occur
near the area of needle insertion, not distal to it, and I doubt the
popliteal is a site of catheter or tumescent needle insertion unless the
target was the small saphenous vein.  But anything is possible.

The lack of turbulence does not rule out a fistula, as the flow depends on
the size of the connection. Although most AV fistulas do result in
turbulence, and more continuous Doppler signals, these findings may depend
on the distance from the connection.

A red, swollen leg could result from infection, another possibility of any
invasive procedure.  This could also result in hyperemic venous and arterial
flow and the swelling could result in pulsatile venous signals due to
compression against the arterial structures.

I would suggest looking carefully around any area of injection with color to
identify possible fistulas,  the presence of interstitial fluid or enlarged
lymph nodes might also be helpful in focusing the physician on the
possibility of infection, which might be the source of your Doppler findings
and the persistent pain and swelling.

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