Risk factors leading to arterial occlusion following diagnostic arteriography

Arteriography may precipitate occlusive complications in stenotic vessels by a toxic effect on the vascular endothelium, leading to intra-arterial thrombosis. The aim of this retrospective study was to determine the incidence of arterial occlusion following arteriography.

We studied 101 consecutive patients (71 male, 30 female; median age 72 years) undergoing percutaneous transluminal angioplasty (PTA) of stenotic lesions, which had been identified on diagnostic arteriograms performed a median of 109 days (range 6-519) previously. One hundred and thirty-one arterial stenoses suitable for PTA were identified in the patient cohort.

Seventeen patients (17%) progressed to occlusion in the period between diagnostic arteriography and PTA. Stenoses in the femoro-popliteal segment (21%) progressed to occlusion more frequently than lesions of the iliac arteries (3%). Independent risk factors were analysed to determine the risk factors predisposing to arterial occlusion following diagnostic arteriography. Both groups were well matched for age and sex. The mode of presentation, the presence of ischaemic heart disease, hypertension, diabetes or current smoking habits did not predict progression of disease to arterial occlusion. However, the rate of occlusion appeared to be influenced by the proportion of patients taking anti-platelet medication (51% in non-occluders as compared to 11% in patients who occluded, 95% CI 0.1 to 10), and to the length of time between arteriography and PTA (median of 92 days in non-occluders as compared to 125 days in patients who occluded, 95% CI 21 to 57).

These data demonstrate that occlusion of pre-existing arterial stenoses following diagnostic arteriography is significantly more frequent in patients not taking anti-platelet medication and when the time interval between arteriography and PTA exceeds 92 days. To minimise thrombotic arterial occlusion both diagnostic and therapeutic procedures should be performed simultaneously, but if a delay is unavoidable, patients should be treated with anti-platelet medication, which reduces the incidence of arterial occlusion.