Complications of intravenous digital subtraction angiography

Extracranial carotid occlusive disease can be evaluated with either intravenous (IV) digital subtraction angiography (DSA) or standard angiography. In a prospective study, complications related to 500 IV DSA examinations occurred in 16.6% of patients, including local complications in 2.0%, systemic complications in 15.0%, and neurologic complications in 3.0%. A permanent neurologic deficit occurred in one patient. Complications related to 150 standard angiograms occurred in 7.3% of patients, including local complications in 4.0%, systemic complications in 3.4%, and neurologic complications in 0.7%. There were no permanent neurologic deficits. Serious systemic and neurologic complications occurred in 8.2% of patients during IV DSA and 2.7% of patients during standard angiography. The rapid injection of high volumes of hypertonic contrast media during IV DSA and the resultant hemodynamic and cardiac electrophysiologic changes account for the higher incidence of complications with IV DSA.