Thank you, Bill and Denice, I guess I did fail to mention we did the EVLA on the 
small saphenous vein. I talked to a another tech that told me to use some 
repositioning techniques and look to see if there were any compression issues 
causes pulsitile flow in the pop. I'm glad to hear that the lack of turbulence 
does not rule out a fistula. The patient has been on antibiotics for 10 days 
with no decrease of symptoms so an infection is a rare possibility. I will keep 
you posted. Thank you so much for your feedback!!

From: Bill Johnson <[log in to unmask]>
To: [log in to unmask]
Sent: Tue, February 22, 2011 10:14:08 PM
Subject: Re: popliteal AV fistula

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 
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