A Survey of Complications of Abdominal Aortography

Abstract

Reviews of the literature in 1953 (10) and 1954 (21) revealed that many complications had been associated with abdominal aortography. Since then, numerous other reports of complications have been published. The frequency of these unfortunate occurrences, however, is not known. In order to obtain data on this aspect, a questionnaire was sent to 450 hospital radiologists and urologists in the United States in April 1956. A reply was received from 301 (66 per cent of the total); complete information was obtained from 194 and incomplete information from 12. Ninety-five of the institutions replied that no abdominal aortograms had been performed. A total of 13,207 abdominal aortograms were collected from the replies to the questionnaires: of these, 12,832 were obtained by the translumbar needle technic; in only 375 was a retrograde femoral catheter used. Insertion of the catheter was performed by a cut-down in 141 cases, and percutaneously in 234 cases. The catheter method, it appears, is being used very little in the United States. Wide differences in the use of abdominal aortography were noted in institutions of approximately equal size. In many large hospitals no more than one or two dozen procedures have been performed. The greatest use of the method appeared to be in the diagnosis and localization of intrinsic diseases of the aorta and its branches. In most centers, its use in renal lesions has become rather limited. especially in the differentiation between renal cysts and neoplasms, because some diagnostic failures have occurred (7). In a few institutions, however, renal arteriography is still being used extensively. At one center, the procedure has been abandoned in the preoperative evaluation of aortic aneurysms. In the collected series of 13,207 abdominal aortograms, there were 37 fatalities attributable to the procedure, a mortality rate of 0.28 per cent. In addition, 98 serious non-fatal complications occurred (0.74 per cent). The overall incidence of serious fatal and non-fatal complications in this study was thus 1.02 per cent. These were all clinically significant and do not include asymptomatic hematomas, asymptomatic renal damage, transient skin or mild systemic reactions, extravasation of the injected contrast medium, or post-aortogram chills or fever. The types of complications are listed in Table I in their probable order of importance, and will be discussed individually. In general, they appeared to be well distributed in both large and small institutions. Of 16 centers at which more than 200 procedures have been performed, only 4 had not encountered one or more major complications. Renal Damage Clinical Manifestations: Following the injection of the aorta or renal artery, there may be immediate pain and tenderness in the flank, costovertebral angle, entire abdomen, or back. Sometimes there are an abnormal rise in the blood pressure and a slowing of the pulse rate.