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Looking at the bibliography of the venous sole of the foot (Lejars), the authors point out the opposite convictions concerning this structure. For some ones, it doesn't exist, but fort the others, it is a very important network of tiny veins, such as it was described by Lejars himself. However, all this studies, are made upon cadavers, injected or not, and must be compared with results from living people by the mean of angiography, non invasive Vascular Assessment, or RMN, which take in account vasomotricity.

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The authors concomitant arterial and venous disorders. On the same patient. They point out the obvious preeminence of arterial disease on venous ones, and discuss about the panel of therapy association usable. They underline the necessity of saving the venous capital.

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The authors consider the Extent of the several anatomical structures which constitute the deep venous network, and the part they can take in the case of deep venous insufficiency. Congenital Vascular diseases are called back in mind when considering Embryology, and point out the extent of the deep venous state; such veins can gather in periarterial plexus, at the muscular Level, and in going past all along main arterial axes. Among all the critical points of these axes, we must keep the popliteal veins, the femoral crossing, and the iliocaval one and elsewhere, the important question of venous valves and communicating and perforating veins. The part of the lymphatic network must be pointed out, because of its extent in the stasis phenomenons.

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The old procedure of lumbar sympathectomy has long been the only chance of avoiding amputation for arteritic patients. Its field of application has shifted as reconstructive surgery and medical therapy made progress, and it is no longer the only solution and has more precise indications. Proper evaluation of its chances of success according to the individual situations allows establishing its potential and limitations. This simple procedure, entailing no risk for the future, deserves remaining among the available means for the treatment of arteritis, despite its age.

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The authors point out the fact that there are few publications on this subject. Besides variations related to functional and hormonal associated with pregnancy, temporary variations occur in the venous system and which take the form of the development of extra-intra pelvic anastomoses at several sites.

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Spontaneous dissections of internal carotid artery are known from more than 30 years and their incidence is now specified, several hundred cases being published. The case reported here illustrates very well the setting problems of this disease and explains why the incidence of the mild forms has been underestimated. The case of a sixty years old man with vague vertiginous feeling, headache and moderate ocular troubles is presented. The clinical signs disappeared within six weeks. The patient was seen again in good health seven years later. The medical practitioner by asking a systematic Doppler examination led to the diagnosis confirmed by arteriography. A complete recanalization of the internal carotid artery occurred. These forms with spontaneous favourable prognosis represent at least 50% of the cases.

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Basing themselves on anatomical and embryological considerations, the authors suggest a distinction between angiodysplasias and abnormalities. They define the characteristics proper to these varieties and establish the bases of therapeutic inferences. They briefly recall the lymphatic malformations. Practical and therapeutic inferences.

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According to an embryological basis, the Authors analyze the development of the vascular system and try to establish a differentiation between angiodysplasias and abnormalities. They define the characteristics of each group and make an attempt at classification. The major characteristics of differentiation are the evolutional aspects and the presence of arteriovenous fistulas.

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Regarding to clinical diseases, the authors emphasize the important part of pelvic veins as collateral flows when iliac channels are occluded. They point out the three mains streams of this collateral network: the obturator veins, the gluteal veins, and the pudendal veins. Longitudinal anastomoses are connected each other by transversal veins such as Santorini plexus, and sacral veins; they allow venous supply from one side to the other when two levels or more are involved.

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The authors give the pattern of several situations where are added phlebological and gynecological diseases. They summarize the several treatments and the practical uses for this. Medicolegal viewpoints are also taken in account.

PIP: 3 areas in which gynecological factors affect phlebology and especially the venous system of the lower extremities are discussed. The presence of small or moderate varices does not contraindicate use of oral contraceptives (OCs), but venous tonics or even anticoagulants should be administered under specific circumstances in women with a tendency toward thrombosis. OCs should be avoided in women with significant venous lesions. If OCs are imperative, the varices should be treated before OC administration is initiated. Women whose syndrome of venous stasis worsens during menstruation or OC use should be carefully examined for gynecological lesions. If no lesions are found and treated, the OCs should be replaced by a nonhormonal method of contraception or the cause of the venous insufficiency should be further explored. OCs should be temporarily suspended for women undergoing sclerotic treatment of their varicosities. Alternatively, limited interventions such as ambulatory phlebectomies under heparin therapy can be substituted, but in these cases stripping should be avoided because of the danger of deep venous thrombosis. The practitioner contemplating treatment of varicosities in women using OCs should bear in mind the possibility of a malpractice charge if phlebitis should develop. The appearance of varices of varicosities accompanied by a peripheral venous stasis syndrome can be 1 of the 1st signs of pregnancy. Such varices in pregnant women represent small exteriorizations of enormous venous dilatations in the pelvis. They are almost never hemorrhagic during delivery and regress rapidly in the postpartum. Their thrombosis, however, can be very grave when it does occur. Varices of pregnancy which do not regress within 3 months' postpartum will be permanent. Different interventions are necessary in the case of preexisting significant varicosities or complicated varicosities during pregnancy. The usual treatments combine support and heparin therapy. The presence of varices does not absolutely contraindicate gynecological interventions. But OCs are formally contraindicated in the case of women with histories of deep phlebitis with sequelae.

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The first dorsal metatarsal artery (MDA) is usually described as the last collateral branch of dorsalis pedis artery (DPA, which anastomoses with the lateral plantar branch of the posterior tibial artery (PTA). Doppler assessment on DMA of a flow does not always mean that DPA is free, but may show a functional plantar arch. The aim of this study was to determinate the patency rate of this plantar arch and to appreciate the part of DPA in the vascularisation of the foot. Anatomical descriptions were compared with our own dissections, (25 cadavers and 55 arteriographies in fetus), angiographic analysis and vascular plastic casts. The functional aspect of this study was made by Doppler examination of DMA using alternative or simultaneous compression of the main arteries of the ankle, until doppler curves were canceled. That was done on healthy volunteers and arteriosclerotic patients. The results show that, from the anatomical viewpoint, the plantar arch is almost always present, since it was found in 88% of adult pieces. Nevertheless, on Doppler examination, the plantar arch was found functional only in 64% of healthy people. The difference between the two rates emphasizes the fact that anatomical anastomosis are note always open, according to the subject and probably to the age. Looking after MDA permeability in patients with arteriosclerosis leads to point out the main vascular access to the foot, for limb salvage, and the leading part of distal anastomosis to keep good trophicity of the toes.

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In reference to four particular cases where a venous thrombosis associated with the use of oral contraceptives, the authors review the various factors of this problem. The importance of the concomitant use of tobacco as well as risk factors such as hyperlipidemia and hypertension, are especially stressed. These four cases, almost of an experimental nature, permit to correlate precisely the interaction between estro-progestative medications and the occurrence of venous thromboses.

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