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 persistent pain and swelling.

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