Of 7333 patients undergoing percutaneous left-heart catheterization procedures during a seven-year seven-month period, 73 patients (1%) underwent 75 operative repairs of catheterization-related vascular complications. The overall incidence of operative repair varied according to the type of percutaneous femoral artery procedure performed: 0.6% for diagnostic heart catheterization, 0.9% for percutaneous transluminal angioplasty, 5.2% for transfemoral balloon valvuloplasty, and 11.5% for intra-aortic balloon pump placement. This suggests that (1) femoral and iliac artery occlusions can and should be repaired promptly while the patient is under local anesthesia; (2) false aneurysms in this clinical setting can be approached directly through the aneurysm cavity; (3) the diagnosis of false aneurysm or arteriovenous fistula can usually be made on clinical grounds alone, without resorting to angiography; (4) venous or arterial patch angioplasty is the preferred technique for small or severely traumatized femoral arteries; and (5) the necessity for operative repair of these lesions will continue to increase in frequency as percutaneous cardiologic diagnostic and therapeutic interventions are used more widely.