A Technic of Postmortem Angiography for Evaluating Arteriosclerosis of the Aortic Arch and Carotid and Vertebral Arteries

Abstract

With the increasing application of carotid and vertebral angiography in defining the stroke syndrome, there has been a greater need for correlation of the atheromatous lesions observed radiographically with those found at autopsy. Although studies of the gross and microscopic anatomy of stenotic lesions involving these vessels are plentiful, there have been few reports describing the postmortem angiographic findings (1). The usual method of injecting a semi-solid or solidifying radiopaque medium into the vessels to be examined is objectionable (1, 2) from the point of view of satisfactory embalming of the face, if not an actual deterrent, and makes impossible proper evaluation of the arteries and the brain by the pathologist. It was necessary, therefore, to devise a technic by which the contrast medium would temporarily distend the injected vessels and then dissipate rapidly. The criteria for this study will subsequently be outlined. Material and Technics One hundred and thirty postmortem examinations were performed. The angiographic technics were designed to satisfy the following requirements: (a) to allow optimum evaluation of stenotic lesions occurring in the branches of the aortic arch and the carotid and vertebral arterial systems; (b) not to interfere appreciably with the performance of the postmortem examination; (c) not to interfere with the embalming procedure. The prosector begins the postmortem examination in the usual fashion, except that the removal of the brain is post- poned until the end of the procedure. A high neck flap is reflected from the “Y” skin incision. While the bowel is being removed and appropriate cultures are being obtained, the great vessels of the aortic arch are dissected free of their investing tissues. The subclavian arteries are followed distal to the scalenus anticus muscle; the vertebral arteries, thyrocervical trunk, costocervical trunk, and internal mammary arteries are identified and freed of their investing tissues. Ligatures of silk are placed about the distal subclavian and the other aforementioned arteries with the exception of the vertebral arteries. The aorta is then cut above the aortic valve and about 6 to 8 cm. distal to the arch (Fig. 1). The body is then eviscerated by cutting the trachea and the esophagus below the clavicles and leaving the neck organs in situ (after the method of Rokitansky). Two plastic catheters (Fr. #14 or #12, depending on the size of the vessels), with a circle of adhesive near the end to prevent withdrawal, are threaded into the carotid arteries, being held in place by the atraumatic application of umbilical tape (Fig. 2). Two liters of saline are perfused through these vessels at approximately systolic pressure to remove clotted blood. The two catheters are then placed in the subclavian arteries in a similar fashion and perfusion of the vertebral arteries is accomplished.