Post-mortem cast angiography in the diagnostics of graft complications in patients with fatal outcome following coronary artery bypass grafting (CABG)

The advantages and limitations of a novel post-mortem angiographic method using solidifying silicone rubber and lead oxide as a contrast medium in detecting coronary artery graft complications on a routine basis were evaluated in a series of 223 consecutive patients with fatal outcome within 30 days...

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Bibliographic Details
Published in:International journal of legal medicine 1999, Vol.112 (2), p.107-114
Main Authors: Weman, S M, Salminen, U S, Penttilä, A, Männikkö, A, Karhunen, P J
Format: Article
Language:English
Subjects:
Aged
Anastomosis, Surgical - adverse effects
Angiography - methods
Aorta - surgery
Aortography
Arteries - surgery
Autopsy
Contrast Media
Coronary Angiography
Coronary Artery Bypass - adverse effects
Coronary Artery Bypass - mortality
Coronary vessels
Coronary Vessels - surgery
Dissection
Female
Graft Occlusion, Vascular - diagnostic imaging
Graft Occlusion, Vascular - etiology
Graft Occlusion, Vascular - pathology
Heart surgery
Humans
Male
Medical imaging
Middle Aged
Postmortem Changes
Prospective Studies
Radiographic Image Enhancement
Retrospective Studies
Rubber
Sensitivity and Specificity
Survival Rate
Veins & arteries
Veins - surgery
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Summary:The advantages and limitations of a novel post-mortem angiographic method using solidifying silicone rubber and lead oxide as a contrast medium in detecting coronary artery graft complications on a routine basis were evaluated in a series of 223 consecutive patients with fatal outcome within 30 days following coronary artery bypass grafting (CABG). Of these patients, 166 (74.4%) were male and 57 (25.6%) female (mean age 61.9 +/- 9). Coronary grafts totalled 660 (3.0 per patient) with 517 aortic and 838 coronary anastomoses. At autopsy, the rubber cast model of the grafts and coronary arterial tree was exposed by a bend scalpel and sites of possible complications were examined. Post-mortem angiographs were re-evaluated and compared with preoperative angiographs and dissection findings. By combining the findings of angiography and heart dissection, 122 (54.7%) of the 223 patients were found to have some type of complication of the graft or the anastomosis. The diagnostic sensitivity and specificity of post-mortem angiography was 100% in assessing narrowing or twisting of the graft as well as narrowing of the aortal anastomosis, whereas these findings were revealed with difficulty by autopsy dissection only. In cases with correct x-ray projection, narrowing and occlusion of the proximal aortal and distal coronary anastomosis were also reliably revealed by angiography. In contrast, graft thrombosis was clearly overdiagnosed by angiography, leading to a lower specificity (84%) but high sensitivity (100%) in detecting this complication. Post-mortem angiography also failed to detect dissection of the wall of the graft or anastomosis. Technical problems with this angiographic method were due to too low perfusion pressure, too rapid polymerizing of the silicone rubber, leakage of contrast medium into the ventricles, or faulty x-ray projections. These results suggest that our post-mortem angiographic technique, yielding a permanent rubber-cast model of the graft and anastomosis site, improves the accuracy of diagnostics of postoperative CABG complications and eases postoperative autopsy dissection, which can now be directed to confirm suspected complications.
ISSN:0937-9827
1437-1596
DOI:10.1007/s004140050211