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In 1983, we had the opportunity to encounter a case of impotence following eveinage in a man aged 58. The complete aetiological investigation of the disorder proved to favour the ligation of an external pudendal artery during the operation, a cause already anticipated by Dr D. Reinharez in 1980, in an article published in Phlebologie, where he described 5 similar cases. In 1984, we demonstrated, thanks to the Doppler velocimeter and also common selective femoral angiography that, contrary to the classic descriptions, approximately 7% of men have a particular anatomical distribution; the external pudendal arteries play a not insignificant haemodynamic role in the vascularization of the erectile organs. Since then, we have encountered further cases of impotence following eveinage. This being so, we wanted to know more about the anatomical relationship between the saphenofemoral venous confluent and the external pudendal arteries such as number, calibre, and variations according to age and sex... In order to achieve this, we requested the collaboration of five surgeons known for their thoroughness, their experience and their competence in venous surgery. They were asked to complete a pre-drawn diagram after each eveinage carried out, and to draw onto it the different arterial and venous branches observed, their calibres, and the relation between them. 140 subjects were included in this study (79 women, 70 men) with longitudinal selection; 256 eveinages were carried out and indexed. The average age of patients was 42.9 years: 40.5 for women, 45.5 for men. The analysis of the results enables us to improve our knowledge of this "strategic" region for the surgeon and the phlebologist, by contributing new anatomical and statistical elements, in particular: the very large number of times that an external pudendal artery is at least encountered during dissection of the saphenofemoral venous confluent: round about 97%; the number of external pudendal arteries, classified usually as 2, proves in fact to be more often one: in about 75-80% of women and 65% of men. Triple pudendals are exceptional; the average calibre of the pudendal artery is 1/3 greater in the male sample than in the female: 0.8 mm v 0.6 mm.(ABSTRACT TRUNCATED AT 400 WORDS)

Among the iatrogenic complications of the surgery of varicose veins, the author has encountered several cases of impotence following stripping of the internal saphenous. Without rejecting the possibility of a psychogenic impotence due to the operation itself, he raises the question of the possible mechanism of this complication. Alter considering the vascularization of the erectile body and the haemodynamic process of erection, he reviews the arterial and venous causes of impotence and sets out the hypothesis which he feels to be the most plausible. Under the arch of the internal saphenous passes the external pudendal artery; injury to this does not usually produce any significant damage, since the erectile body of the penis is vascularized by the internal pudendal artery. But if as a result of a congenital anomaly of the internal pudendal, the supply derives from the external pudendal, ablation of the latter, sometimes carried out by surgeons in the course of ligature of the arch of the internal saphenous vein, could explain this complication. If this hypothesis proves correct, it would be necessary to require surgeons to touch the external pudendal artery in order to avoid this complication, which though exceedingly rare, is psychologically traumatic.