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Local complications of femoral artery catheterization are less frequent than those occurring after puncture of other sites. Nevertheless, their prevalence is estimated to be 0.5 to 1%. Some of them are health-threatening. Fifty-one arterial obstructions, 18 hematomas, 38 pseudoaneurysms and 11 arteriovenous fistulas have been operated on during a 25 years period. They were responsible for 4 death and 1 above-knee amputation. During the same period, several arteriovenous fistulas and pseudoaneurysms were treated conservatively. Our study and the literature show that Duplex-scan allow a management of these complications more eclectic than previously. Arterial obstructions should be operated on rapidly in case of acute ischemia with neurologic deficit. When the ischemia is less severe, heparin therapy may help the lysis of the clot. If not, simple thrombectomy is sufficient when the arteries are normal while more complete revascularizations after angiographic evaluations are necessary in case of atherosclerotic arteries. Hematomas should be avoided by local compression during a period which should be longer when the hole is large or when anticoagulation is used. An implantable bio-absorbable device has been used with good results in another study. Increasing hematomas and hematomas responsible for neurologic symptoms should be operated on. Blood restoration should be rigorous in patients with cardiac disease. Pseudoaneurysms may be easily diagnosed and controlled with Duplex-scan. Ultrasound-guided compression during 10 to 20 minutes periods should be used before deciding surgical repair.(ABSTRACT TRUNCATED AT 250 WORDS)

During the 28th Meeting of the Collège Français de Pathologie Vasculaire, twelve experts, six angiologists and six surgeons were asked to choose a first intention treatment for 32 case reports of patients with varicose veins based on physical examinations and écho-Doppler findings. The audience made their choice simultaneously by an electronic voting system. In a large number of cases, several therapeutic options were possible. The greater saphenous vein can often be retained in first intention situations with the possibility that several years later the prognosis of the limb may depend on the presence of this vein, particularly in life threatening cases where it is needed for arterial bypass surgery. In some cases it is clear that the greater saphenous vein does not need to be removed and in others, deterioration is clearly sufficient to justify removal. In many cases, the choice between the two options is a decision to be made. Indications depend on the clinical presentation and echo-Doppler findings. The caliber of the greater saphenous vein must be determined for the entire length of the vein. Whenever possible, veins with a diameter below 8 mm should be preserved and the patients should be informed on why the choice was made. Whatever treatment has been chosen, recurrence may be observed and periodic follow-up is required.

It is unwise to treat patients with varicose veins without thinking about the possibility of atherosclerotic disease occurring later on. The various procedures of stripping, as well as cryosurgery and sclerosis injections in the saphenous veins destroy veins which are at present the best material for femoro-tibial, femoro-popliteal and coronary bypass. Every year, a great deal of limb salvages cannot be achieved because saphenous veins have been previously removed. As arterial disease occurs one or several decades after the venous complaint, every patient with varicose problems may be concerned. Further more, contrary to a frequent opinion, great saphenous veins of varicose patients are often suitable for arterial bypass. As Doppler combined to duplex scan allow to draw a precise map of the superficial venous channels with their endings, amount of flow back, and caliber of the saphenous veins, it is now possible to propose to most patients conservative procedures: ambulatory phlebectomy or sclerosis injections of peripheral veins in case of minor reflux, crossectomy or CHIVA (Ambulatory Hemodynamic Cure of Venous Insufficiency) in case of major reflux, or association of the various technics. Thus, destructing treatments of saphenous veins should be only proposed to patients whose veins are obviously unsuitable for arterial bypass.