Minimally invasive treatment of varicose veins is becoming increasingly popular with both patients and physicians. Endovenous laser therapy has been shown to be safe and effective but the rare complication of iatrogenic creation of arteriovenous fistulas has been described. One case of fistulation between the external iliac artery and vein has been published. We report two further cases and describe their management.

CommentaryInfrainguinal arterial bypass remains the treatment of choice for patients with multilevel arterial occlusion who are suffering from critical limb ischemia. The use of vein (saphenous and/or arm) as the conduit (used either reversed or in situ) has been associated with the best long-term results. Early patency is directly related to technical perfection during construction of the bypass. Intraoperative and early post operative duplex assessment identifies flow-limiting lesions in the three key aspects of the bypass; the arterial inflow vessel, the conduit and the outflow target vessel. Long-term patency is also dependant upon ensuring that the same three components do not develop significant flowlimiting lesions over time. Studies from single centers have demonstrated that the early identification of critical flow-limiting lesions improves the limb salvage of Vascular Medicine 2006; 11: 137-138 Is duplex surveillance of value after leg vein bypass grafting? Davies AH, Hawdon AJ, Sydes MR, Thompson SG, on behalf of the VGST Participants. Circulation 2005; 112: 1985-91. TF Lindsay and AD DueckQuestion: Is duplex scanning superior to clinical vein graft surveillance with respect to amputation rates, quality of life, and cost following femoropopliteal or femorocrural vein bypass graft? Population: Between 1998 and 2001, patients from 29 centers in the UK and Europe who had a patent vein graft 30 days following femoropopliteal or femorocrural vein bypass surgery for critical ischemia, claudication or symptomatic popliteal aneurysms were recruited for the study. Methods and results: There were 592 patients included in this multicenter randomized controlled trial. Patients with patent vein grafts at 30 days were randomized to receive or not receive duplex surveillance in addition to clinical examinations and ankle-brachial indices at 6 weeks (time of recruitment), and 3, 6, 9, 12 and 18 months. Stenoses within grafts were defined as slow peak systolic velocity (Ͻ45 cm/s), or a ratio of peak systolic velocity in an area of stenosis to any other area within 2 cm of Ͼ2. The primary endpoints were time to amputation and time to vascular mortality (MI, CHF, arrhythmia or CVA). Secondary outcomes included graft patency (whether primary or secondary, assisted or unassisted), cost, and quality of life as measured by SF-36 and EuroQol. The primary endpoints were analyzed according to an intention-to-treat analysis using Cox-regression and Kaplan-Meier life tables, while secondary outcomes were analyzed by the Mann-Whitney test and a t-test. Approximately 11% of patients died during the study, while 12% withdrew (45% of which were due to amputations). There were significantly more diagnostic interventions in the clinical follow-up group (31% vs 22%, P ϭ 0.01). Between the clinical follow-up and duplex groups, there was no difference in amputation rate (7% vs 7%) or vascular death rate (3% vs 4%). A greater proportion of patients in the clinical follow-up group had a stenosis in the graft identified at the end of the ...

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