Arteriovenous fistula after endovenous laser treatment of the short saphenous vein

Reports of major complications from endovenous laser treatment of saphenous veins with use of perivenous tumescent anesthesia are very rare. The author reports a major complication of endovenous laser treatment, the creation of an arteriovenous (AV) fistula. The fistula was created between the short saphenous vein (SSV) and the superficial sural artery in the popliteal fossa during endovenous laser treatment of the SSV. The proximity of the superficial sural artery and the SSV in the popliteal fossa increases the risk of fistula formation. Color-flow Doppler ultrasonography can demonstrate potentially dangerous anatomic relationships between the vein segment intended for treatment and adjacent arteries. Recognition of these relationships should increase the operator's ability to minimize the risk of AV fistula formation.