Lund, Fredrik; Diener, Lennart; Ericsson, Jan L. E.
March 1969
Angiology;Mar1969, Vol. 20 Issue 3, p155
Academic Journal
A technique for the postmortem intraosseous phlebography of the legs by injection of contrast medium into the calcaneous is described. The results of a comparative postmortem pathoanatomic and phlebographic study are reported in which intraosseous phlebography and complete venous dissection of the lower limbs were performed. Venous thrombosis was found in 43 of 100 geriatric cases (in 65 legs out of a total of 199 investigated, i.e., in 33 per cent of legs. Extensive thrombi affecting both the veins of the lower leg and the iliofemoral veins were frequent; they comprised 65 percent of all thrombi (45 per cent were continuous and 20 per cent discontinuous), whereas 20 per cent were localized in the iliofemoral veins. Exclusive localization in the iliofemoral veins indicates a primary site of origin in this area of a comparatively large number of venous thrombi in the leg. Apparently early primary thrombi were often adherent to valve pockets, from which they seemed to originate. In the 65 thrombosed legs, partial failure of phlebography to reveal thrombi occurred in 10.7 per cent (thrombosis was correctly diagnosed in one venous trunk but not in the other). Complete failure of phlebography was noted in only 3.1 per cent of the thrombosed legs. A false-positive phlebographic diagnosis of thrombosis (mainly due to misinterpretation of clots) was experienced in 7 out of 134 legs pathoanatomically free of thrombosis (5 per cent). It is envisaged that the method of postmortem intraosseous phlebography may be used as a supplement to ordinary postmortem examination, especially in systematic studies of thromboembolic disease states. Certain modifications of the technique and a broader experience concerning the interpretation of the postmortem phlebograms appear, however, to be needed prior to the routine application of the technique. The radiographic postmortem examination of the veins may not only be used as a guidance and supplement to autopsy; it may be of considerable diagnostic value in certain cases where regular postmortem autopsy cannot be performed. Preliminary observations in this study may suggest that extensive angiographic investigations for postmortem diagnostic purposes are feasible since both the inferior and superior caval systems as well as the right side of the heart and the pulmonary arteries may be visualized under certain conditions making possible the diagnosis of pathologic conditions such as tumors, pulmonary emboli, and septal defects in the heart.


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