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Two-Step Postmortem Angiography with a Modified Heart–Lung Machine: Preliminary Results

¹ Center of Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
² Institute of Forensic Medicine, University of Lausanne, Rue du Bugnon 21, CH-1005 Lausanne, Switzerland.
³ Department of Cardiovascular Surgery, University of Bern, Inselspital, Bern, Switzerland.
⁴ Institute of Diagnostic Radiology, University of Bern, Inselspital, Bern, Switzerland.
⁵ Institute of Anatomy, University of Bern, Bern, Switzerland.

OBJECTIVE. The purpose of this study was to adapt and improve a minimally invasive two-step postmortem angiographic technique for use on human cadavers. Detailed mapping of the entire vascular system is almost impossible with conventional autopsy tools. The technique described should be valuable in the diagnosis of vascular abnormalities.

MATERIALS AND METHODS. Postmortem perfusion with an oily liquid is established with a circulation machine. An oily contrast agent is introduced as a bolus injection, and radiographic imaging is performed. In this pilot study, the upper or lower extremities of four human cadavers were perfused. In two cases, the vascular system of a lower extremity was visualized with anterograde perfusion of the arteries. In the other two cases, in which the suspected cause of death was drug intoxication, the veins of an upper extremity were visualized with retrograde perfusion of the venous system.

RESULTS. In each case, the vascular system was visualized up to the level of the small supplying and draining vessels. In three of the four cases, vascular abnormalities were found. In one instance, a venous injection mark engendered by the self-administration of drugs was rendered visible by exudation of the contrast agent. In the other two cases, occlusion of the arteries and veins was apparent.

CONCLUSION. The method described is readily applicable to human cadavers. After establishment of postmortem perfusion with paraffin oil and injection of the oily contrast agent, the vascular system can be investigated in detail and vascular abnormalities rendered visible.

Keywords: minimally invasive autopsy • iodized oil • noninvasive autopsy • postmortem angiography • virtual autopsy

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