Complications of “No Arteriography”

Vascular opacification studies are becoming increasingly important in diagnostic radiology, in part owing to recent advances in surgery and in part because of the unique value of these procedures in diseases of abdominal and retroperitoneal structures which previously resisted diagnosis by conventional radiographic technics. Abnormalities of the cardiovascular system considered inoperable a decade ago are now successfully treated after an accurate preoperative diagnosis. Paralleling the increased frequency of vascular examinations is a growing number of reports of complications resulting from their use (1–3). We have been uncertain as to what extent these complications allegedly due to the angiographic procedure were iatrogenic or actually a complication of the patient's primary disease. In our department, several days often elapse between scheduling and performing an elective arteriographic procedure. Occasionally, such scheduled studies are cancelled, and we have investigated the causes for cancellation. When these causes were complications of the primary disease, occurring within forty-eight hours of the scheduled examination, we have labeled them complications of “no arteriography.” We have also, of course, kept careful data of the untoward reactions taking place after angiography. Material and Result This report is based on an analysis of more than 1,600 consecutive studies of the cardiovascular and abdominal and peripheral vascular systems performed during the past three years at the Graduate Hospital of the University of Pennsylvania. Cerebral vascular examinations were not included in this analysis. We have followed Lang's classification (1) of three categories of postangiographic complications: minor, serious (nonfatal), and fatal. In our series, the incidence of minor complications such as localized hematomas, nausea, hives, temporary arterial spasm, etc. has been similar to that reported by others (3 to 5 per cent) (1). Those without sequelae have not been included in the tabulations for this report. Nine serious (nonfatal) and 5 fatal complications following arteriography are recorded in more detail in Tables I and II. The incidence of complications of “no arteriography” is strikingly similar. In this group there were 9 serious (nonfatal) and 6 fatal complications, which are listed in Tables III and IV. Discussion Abrams (4) pointed out the difficulty in analyzing the relationship of the patient's preangiographic condition to any post-angiographic complication which may occur. Our material indicates an almost identical number of complications due to the primary disease occurring within forty-eight hours prior to a scheduled vascular opacification study and the number following such a procedure.