Complications of arteriography in a recent series of 707 cases: factors affecting outcome

Seven hundred and seven consecutive arteriograms were analyzed regarding the effects of various factors on clinical outcome. Complication rates were assessed regarding age, inpatient or outpatient procedures, operator caseload, clinical indication, preoperative renal disease, approach site, graft puncture, selective injection of arteries, amount of contrast, and catheterization time. The major complication rate for arteriography was 7% and the mortality rate was 0.7%. The complication rates for femoral and axillary approaches, respectively, were local, 9% and 27%; nervous system, 1.4% and 11%; and major, 6% and 24% (p = 0.0075, p < 0.0001, and p < 0.0001, respectively). Brachial plexus injury was noted in 13% of the patients undergoing the axillary approach. There was a trend toward a higher overall complication rate in four-vessel arch aortograms with selective vs. nonselective carotid injections, but both had similar neurologic complications. More contrast was used in patients with post-arteriogram renal failure, 224 ml vs. 168 ml. The complication rates were directly related to catheterization time, amount of contrast, and number of vessels punctured. There was a trend toward a higher complication rate in physicians with a lower caseload. In conclusion, arteriography is still associated with significant morbidity and mortality. The transfemoral approach is safer than the transaxillary route, even in patients with femoral graft punctures.