The incidence of arterial puncture site complications after transfemoral catheterization is mainly dependent on patient related and procedure related factors. Color flow duplex sonography is the method of choice for detection of the arterial injuries and a possibility for noninvasive ultrasound guided compression therapy of pseudoaneurysms. In our own experience we describe the vascular surgical treatment of 172 patients with 159 pseudoaneurysms (26 combined with AV fistula), 10 arterial dissections and thrombosis, 3 dislocated and lost intravascular materials. Indications for vascular surgical treatment are failure of compression therapy to pseudoaneurysms and arteriovenous fistulas, pain with progressive enlargement of the pseudoaneurysm, arterial dissections and thrombosis with limb ischemia, and anticoagulation. Surgical repair requires a differential vascular corrective treatment.