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Traditional treatment for great saphenous vein (GSV) insufficiency includes high ligation of the saphenofemoral junction and subsequent stripping of the GSV. However, the considerable morbidity and patient dissatisfaction associated with surgical treatment led to development of alternative techniques and intravenous laser treatment (EVLT) has emerged as a minimally invasive alternative to surgery. Formation of arteriovenous fistulas (AVF) during EVLT is extremely rare. In this study we report a case of AVF between a segment of the lateral accessory saphenous vein and the superficial femoral artery that was identified by ultrasound. Initially, two attempts were made at compression with a linear-array transducer without success, then alternatively surgery was performed without complications, leading to resolution of the AVF. This case report highlights the importance of ultrasound follow-up after EVLT, both for monitoring the effectiveness of the method and for diagnosis and early treatment of its complications.