Complications of transfemoral arteriography requiring surgery are rare but carry significant morbidity. To evaluate clinical factors that might relate to such complications, we retrospectively reviewed our experience from January 1, 1985, to December 31, 1988 (four years). Forty-seven complications requiring surgery occurred among 10,589 cases. The risk was higher after cardiac catheterization than after peripheral arteriography (0.55% versus 0.17%, p less than 0.025). In nearly 40% of these cases, arterial puncture was not in the common femoral artery. Acute bleeding complications were more likely among patients with puncture outside the common femoral artery (p less than 0.001). Older patients and women were at slightly higher risk for complications requiring surgery, but this difference was not statistically significant. The frequency of bleeding complications was not significantly higher among patients who were anticoagulated following the procedure. The distribution of puncture sites was identical in obese and nonobese patients. Three patients died (two from myocardial infarction, one from multisystem organ failure). Two limbs did not improve; one required major amputation. Four limbs had persistent paresthesia and two had persistent weakness. We conclude that complications of transfemoral arteriography requiring surgery occur more frequently among patients who are undergoing cardiac catheterization and who suffer aberrant punctures. Age, sex, body habitus, and anticoagulation have less impact on patient risk.