COMPLICATIONS OF PERIPHERAL ARTERIOGRAPHY - A NEW SYSTEM TO IDENTIFY PATIENTS AT INCREASED RISK

Purpose: The most quoted literature on arteriographic complications is based on self-reports collected during the mid 1970s. We sought to de termine whether those results remain valid despite changes in arteriog raphic practice and whether patient subgroups at increased risk could be identified. Methods: Five hundred forty-nine consecutive patients w ere examined after arteriography and twice over 72 hours. Patients wer e telephoned at least 2 weeks later to identify delayed complications. The sample was divided into two groups to allow independent validatio n of suspected prognostic factors. Results: The rate of major complica tions was 2.9% (16/549), but varied from 0.7% to 9.1% among three stra ta of relative risk. Rates were highest in patients studied for suspec ted aortic dissection, mesenteric ischemia, gastrointestinal bleeding, or symptomatic carotid artery stenosis and lowest in patients with tr auma or aneurysmal disease. Patients studied for claudication or limb- threatening ischemia had intermediate risk (2.0%), Within these strata , congestive heart failure and furosemide use were the only variables independently associated with a significantly increased complication r ate. Conclusions: Previous reports have overestimated the risk of arte riography for trauma or aneurysm but substantially underestimate the r isk for patients with other common conditions. Such stratified complic ation rates are essential to understand relative costs and benefits of arteriography and other vascular imaging modalities in specific clini cal situations.