Identification of arteriovenous anastomoses by duplex ultrasound. Implications for the treatment of varicose veins.

BACKGROUND

It has been suggested that arteriovenous anastomoses (AVA) may contribute to the etiology of varicose vein disease. Duplex ultrasound has recently assumed a major role in the diagnosis of venous disease. This noninvasive method can serve as a research tool to better elucidate the role of AVA, and as a guide to the treatment of varicose veins.

OBJECTIVE

To determine the incidence and location of AVA identifiable by duplex ultrasound in a population with clinically apparent varicose veins due to underlying saphenous vein reflux.

METHODS

The presence and location of AVA detected by duplex ultrasound were noted in 510 patients with varicose veins due to Doppler-positive saphenous vein reflux from three private practices.

RESULTS

Twenty-six AVA were found in 19 patients (incidence 3.7%), mostly in the distal half of the long saphenous system. AVA were represented equally on both right and left sides, and regardless of previous vein stripping. Three AVA were found at the base of venous ulcers. AVA were more easily detected using higher resolution ultrasound.

CONCLUSION

AVA occurring in association with saphenous vein disease and identified using duplex ultrasound are usually found below the knee in the long saphenous system, and sometimes at the base of venous ulcers. Knowledge of their presence and location may help to avert complications of sclerotherapy, and guide the approach to treatment.