A Survey of the Complications of Percutaneous Retrograde Arteriography

Abstract

The abundance of publications on the various applications of retrograde percutaneous arteriography in the recent literature reflects the great interest in this method. Sporadic references to complications have appeared in several papers (1, 2, 5, 9, 11, 17, 22, 23, 25, 26, 35, 36, 39, 41–43, 45, 48, 51, 55, 58, 59, 61–64). Abrams in 1957 reported a mortality rate of 1.7 per cent in thoracic aortography (2). A survey of the complications of translumbar aortography by McAfee revealed a mortality rate of 0.28 per cent and an incidence of serious nonfatal complications of 0.74 per cent (53). The present paper attempts to arrive at a comparable estimate of the dangers of percutaneous retrograde arteriography. A questionnaire was sent to 300 hospital radiologists, urologists, and vascular surgeons in the United States in April 1962. Two hundred and four replies were received of which 142 were adequate for statistical analysis. The returns were carefully scrutinized for completeness of data to provide a reference source from which information might be derived for balancing the risk of the procedure against the diagnostic information disclosed. Seven fatal and 81 serious complications were recorded in 11,402 tabulated procedures, representing a mortality rate of 0.06 per cent and a serious complication rate of 0.7 per cent. The complication was termed serious if increased morbidity or major late sequelae could be causatively related to the examination. A minor complication was defined as a condition resulting only in transient discomfort. The minor complication rate was relatively high (approximately 3 per cent). Minor Complications The minor complications of retrograde percutaneous arteriography are, in order of frequency, temporary arterial spasm, asymptomatic local hematomas, asymptomatic intramural or subintimal injections, and perforation of major vessels without late sequelae. Multiple traumatic punctures, poor local anesthesia, traumatic advancement of the guide wire or catheter, and excessively long catheterization procedures appeared to be the most common causes for temporary arterial spasm. Inadequate manual compression at the puncture site or improper application of pressure dressings seemed to predispose to the formation of local hematomas. The experience of the operator and the precision of the technic were apparently the most significant factors influencing the incidence of minor complications. Diabetic patients and patients with arteriosclerotic disease in the advanced age group were particularly prone to such complications. The latter group appeared to sustain many intramural injections or perforations of their tortuous vessels. Brachial artery catheterization showed a significantly higher rate of complications than femoral catheterization.