Venous contrast extravasation during digital subtraction angiography.

Six episodes of contrast extravasation occurred in 5 patients during intravenous digital subtraction angiography in a period of 9 months. The extravasations were into the mediastinum (3), pericardium (1), and right atrial wall (2). These occurred using a variety of catheters, all the same size (5.0 F--1.67 mm). Three were Katzen catheters, one had a pigtail configuration, and two were straight catheters. We believe that the extravasations are due to three main factors. The first is catheter-related, owing to the small size (5.0 F) creating recoil and marked jet stream effect due to the large volume and pressure that must be delivered through the side holes. The second factor is related to positioning of the catheter in the superior vena cava. Finally, the respiratory phase at the time of injection becomes crucial. Understanding of these factors may help to decrease this potentially serious complication.