Objectives: To determine whether patients with Kawasaki Disease (KD) undergoing percutaneous catheter angiography were at increased risk of arterial complications at the point of arterial access compared to patients with structural heart abnormalities, but normal vessels. Background: Systemic arterial damage can occur as a result of KD. Methods: Medical histories of all patients with KD undergoing percutaneous catheter angiography at The Hospital for Sick Children between January 1990 and August 2008 were reviewed. Results: A total of 44 patients with KD underwent 82 catheter procedures. Of these, 3 were associated with important arterial complications (2 males; age: 4 months, 3 and 17 years). All patients who experienced complications had multiple large and/or giant coronary artery aneurysms and two were within 3 months of the acute phase of KD. All patients developed pseudoaneurysms of the femoral artery which had been utilized for catheter access. All pseudoaneurysms were treated with ultrasound-guided thrombin injection and compression, and resolved with no long-term complications. One patient also developed a substantial arteriovenous fistula of the femoral circulation which had to be surgically repaired with no permanent sequela. Odds for arterial complications in patients with KD were 10.4 times greater (95%CI: 3.2–33.8) than that noted for the general pediatric cardiac catheterization population (3.6% vs. 0.4%, P < 0.0001) which indicates higher risk associated with arterial access in patients with KD. Conclusions: Greater care in obtaining arterial access for angiography is warranted, especially in the first month directly following the acute phase, possibly related to systemic arterial damage associated with KD. © 2009 Wiley-Liss, Inc.