title: Arteries masquerading as varicose veins: A trap for phlebologists.
abstract: Ultrasound guided sclerotherapy may be complicated by intra-arterial injections resulting in significant tissue necrosis. Here, we present a 69-year-old man with a history of right small saphenous vein "stripping", presenting for the treatment of symptomatic lower limb varicose veins. Duplex ultrasound of the right lower limb outlined the pathway of venous incompetence. Despite the history of "stripping", the small saphenous vein was present but the sapheno-popliteal junction was ligated at the level of the knee crease. No other unusual findings were reported at the time. During ultrasound guided sclerotherapy, subcutaneous vessels of the right posterior calf were noted to be pulsatile on B-mode ultrasound. Treatment was interrupted. Subsequent angiography and sonography showed absence of the right distal popliteal artery. A cluster of subcutaneous vessels of the right medial and posterior calf were found to be arterial collaterals masquerading as varicose veins. Injection sclerotherapy of these vessels would have resulted in significant tissue loss. This case highlights the importance of vigilance at the time of treatment and the invaluable role of ultrasound in guiding endovenous interventions.
authors: Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St. Vincent's Centre for Applied Medical Research (AMR), St. Vincent's Hospital, Sydney, Australia.
authors: L
authors: L
authors: Jones
authors: Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St. Vincent's Centre for Applied Medical Research (AMR), St. Vincent's Hospital, Sydney, Australia Phlebology Vascular Laboratory, Sydney Skin and Vein Clinic, Sydney, Australia St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia kparsi@stvincents.com.au.
authors: K
authors: K
authors: Parsi
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D055109:Ankle Brachial Index; D003097:Collateral Circulation; D003951:Diagnostic Errors / Q000517:prevention & control; D006801:Humans; D007049:Iatrogenic Disease; D007269:Injections, Intra-Arterial / Q000009:adverse effects; D008297:Male; D009336:Necrosis; D011150:Popliteal Artery / Q000000981:diagnostic imaging* / Q000293:injuries / Q000503:physiopathology; D011673:Pulsatile Flow; D015911:Sclerotherapy / Q000379:methods; D016909:Tibial Arteries / Q000000981:diagnostic imaging; D018084:Ultrasonography, Interventional; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*
keywords: Sclerotherapy; duplex ultrasound; foam sclerotherapy; varicose veins