Pulmonary arteriography in the high-risk patient

Pulmonary arteriography is an invasive but relatively safe diagnostic procedure. It is generally believed that the presence of pulmonary hypertension is one risk factor that increases the likelihood of a major complication. To assess the magnitude of risk, the reports on 1,434 patients who underwent pulmonary arteriography were retrospectively reviewed, and the occurrence of complications in the 388 (27%) patients with pulmonary hypertension was noted. Major complications related to contrast material injection (excluding allergic reactions) occurred in 30 (2%) of the 1,434 examinations and included two deaths from acute cor pulmonale. Six complications occurred in the 388 patients with pulmonary hypertension and/or elevated right ventricular end-diastolic pressure (RVEDP). The two deaths occurred in patients with severe pulmonary hypertension and elevated RVEDP. Most patients with severe cardiopulmonary compromise tolerated angiography well. The increased risk of studying this group of patients is modest and must be weighed against the potential therapeutic benefits to the patient.