7 Angiography and Interventional Radiology

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Catheter replacement of the needle in percutaneous arteriography: A new technique.

Acta radiol. 39 (1953): 368–376 S.I. Seldinger

Percutaneous trocar (needle) nephrostomy in hydronephrosis.

JAMA (1955) 157: 891–894 W.E. Goodwin, W.C. Casey, W. Woolf

Cine coronary arteriography.

Circulation 20 (1959): 773–774

F.M. Sones, E.K. Shirey, W.L. Proudfit, R. Westcott

Mesenteric Arteriography.

Am J Roentgenology 86 (1961): 103–113 A.R. Margulis, P. Heinbecker

Transluminal treatment of arteriosclerotic obstruction:

description of a new technique and a preliminary report of its application.

Circulation 30 (1964): 654–670 C.T. Dotter, M.P. Judkins

Selective coronary arteriography.

Radiology 89 (1967): 815–824 M.P. Judkins

Non-operative retained biliary tract stone extraction.

A new roentgenologic technique.

Am J Roentgenology (1973) 117 (2): 388–399 H.J. Burhenne

Perkutane Rekanalisation chronischer arterieller Verschlüsse mit einem neuen Dilatationskatheter.

Dtsch. Med. Wschr. 99 (1974): 2502–2505 A.R. Grüntzig, H. Hopff

Transluminal dilatation of coronary-artery stenosis.

Lancet ii (1978): 263 A.R. Grüntzig

Percutaneous billary drainage, technical and catheter related problems in 200 procedures.

Am J Roentgenology (1982) (Jan) 138 (1): 17–23 P.R. Mueller, E. van Sonnenberg, J.T. Ferrucci

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Expandable intrahepatic portacaval shunt stents:

early experience in the dog.

Am J Roentgenology (1985) 145: 821–825 J.C. Palmaz, R.R. Sibbitt, S.R. Reuter et al.

Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty.

NEJM 316 (1987): 701–706 U. Sigwart, J. Puel et al.

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Interventional Radiology

The subject of interventional radiology developed soon after the discovery of X-rays and continued unabated throughout the last century. The term interventional radiology itself was coined by Margulis in 1967 to describe the growing body of manipulative procedures performed by a physician skilful in radiological techniques and experienced in the clinical problems.

Interventional radiology really began in the 1920s and the first use was in the treatment of intussusception in children. In 1921 Burckhardt and Muller reported on the percutaneous puncture of the gallbladder both in cadavers and in vivo.

In 1929 the first documented human cardiac catheterization was performed by Dr Werner Forssman in Eberswalde, Germany. In 1941 Cournand and Richards employed the cardiac catheter as a diagnostic tool for the first time and used cardiac catheterization to measure cardiac output. These three pioneering re- searchers were awarded the Nobel Prize in 1956.

In 1953, Seldinger described a new method of angiography using catheters rather than the direct needle itself. This opened up the way for pioneering work in angiography throughout the latter half of the 20th century. Odman, Tillander and Edholm performed pioneering early studies on selective angiography soon after Seldinger‘s original description and these techniques were introduced around the world by the pioneers in their respective countries.

The diagnostic coronary angiogram was pioneered by the labors of Dr Mason Sones in 1958. This led to the concept of dilating the tubes and in 1964 transluminal angioplasty was introduced by Dr Charles T. Dotter. Meanwhile Dr Judkins introduced his catheters for the performance of coronary angiography in 1967. In 1974 Dr Andreas Gruentzig performed the first peripheral human balloon angioplasty. In 1976 Dr Gruentzig presented the results of his animal studies of coronary angioplasty at the American Heart Association meeting, where the delegates soon realized that this was a very important new technique. In 1977 Andreas Gruentzig performed the first percutaneous transluminal coronary angioplasty on an awake patient in Zurich. In 1978 Myler in San Francisco and Strertzer in New York performed the first cases in the United States. Intravascular coronary stents were reported in the 1980s, with an important contribution made by U.

Sigwart. The use of stents in the peripheral vasculature had been pioneered by the studies of Palmaz and Strecker. The first stents developed by Dotter were made of nitinol. Gianturco introduced his self-expandable Z stent, Strecker a knitted tanta- lum stent and Palmaz a balloon expandable stent. Today insertion of stents in the peripheral vascular system is routinely performed after angioplasty in order to keep the vessels patent.

In the biliary system percutaneous transhepatic cholangiography was first described in 1937. Extraction of retained common duct stones was reported in 1962 by Mondet. Burhenne, however, built up a formidable experience with this particular technique with a success rate of 95% in 661 patients treated between 1972 and 1979. Stents were used in the biliary system as early as 1978. Today they are used in the peripheral vascular system through the shunts, in the tracheo-bronchial tree for stenosis from tumour, in the biliary tract for stenosis from tumours and in the urinary tract for urethral strictures and ureteric strictures.

Interventional radiological techniques for drainage of abscesses under ultrasound control were pioneered by Smith and Bartrum in 1974. CT-guided abscess drainage and image-guided biopsies were subsequently introduced by many workers, including Van Sonnenberg and his team, and have now become routine radiological practice.

Introduction 433

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Pioneering advances in interventional techniques continue unabated, and in a short introduction such as this it is not possible to do justice to all the innovators who have contributed to the development of image-guided therapeutic maneu- vres.

References

Burckhardt H, Muller W (1921) Versuche über die Punktion der Gallenblase und ihre Röntgendarstellung. Deutsche Zeitschrift für Chirurgie 162: 168-197

The first report of the percutaneous puncture of the gallbladder

Huard P, Do-Xuan-Hope (1937) La ponction transhepatique des canaux biliares. Bull Soc Med Chir de l’Indochine 15: 1090-1100

First report of percutaneous transhepatic cholangiography

Mondet A (1962) Tecnica de la extraccion incruenta de los calculos en la litiasis residual del coledoco. Bol Soc Cir B Aires 46: 278-290

Early report of retained common bile duct stone extraction through a t-tube

Burhenne HJ (1980) Garland Lecture. Percutaneous extraction of retained biliary tract stones: 661 patients. AJR 134: 888-898

Large series of biliary stone extraction percutaneously

Burhenne JH (1974) Nonoperative roentgenologic instrumentation techniques of the post- operative biliary tract: Treatment of biliary stricture and retained stones. Am J Surg 128: 111-117

Burcharth F (1978) A new endoprosthesis for nonoperative intubation of the biliary tract in malignant obstructive jaundice. Surg Gynecol Obstet 146: 76

First report of endoprosthesis for biliary drainage

Carrasco CH, Wallace S, Charnsangavej C, et al. (1985) Expandable biliary endoprosthesis:

An experimental study. AJR 145: 1279 Early experimental study on biliary endoprosthesis

Coons HG (1983) Carey PH Large bore long biliary endoprosthesis (biliary stents) for im- proved drainage. Radiology 148: 89-94

Early study of stent placements with 71 Teflon stents placed in 62 patients

Coons HG (1989) Self-expanding stainless steel biliary stents. Radiology 173: 979-983 A series of 30 patients with Gianturco stents in the bile ducts showed good results, especially in benign strictures

Lammer J, Neumayer K (1985) Biliary drainage endoprosthesis: experience with 201 placements. Radiology 159: 625

Series showing low complication rates

Dick R, Gillams A, Dooley JS, et al. (1989) Stainless steel mesh stents for biliary strictures.

J Intervent Radiol 4:95-98

Irving JD, Adam A, Dick R, Dondelinger RF, Lunderquist A, Roche A (1989) Gianturco expandable metallic stents: results of a European clinical trial. Radiology 172: 321-326 One of the first trials of transhepatic biliary endoprosthesis insertion

Goodwin WE, Casey WC, Wolf W (1955 ) Percutaneous trocar (needle) nephrostomy in hydronephrosis. Jama 157: 891-894

The first description of a series of percutaneous nephrostomies.Thomas Hillier from London in 1865 is credited with having done repeated nephrostomies in a four year old boy to drain abscesses although this was largely forgotten till the middle of the twentieth century

Odman P (1956 ) Percutaneous selective angiography of the main branches of the aorta (preliminary report) Acta Radiologica 45: 1-14

Edholm P, Seldinger SI (1956) Percutaneous catheterisation of the renal artery. Acta Radiologica 45: 15-20

Tillander H (1956) Selective angiography of the abdominal aorta with a guided catheter.

Acta Radilogica 45: 21-26

The above three papers were pioneering studies in selective angiography which followed on from Seldinger‘s original description

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Dotter CT (1969) Transluminally placed coilspring endoarterial tube grafts: long-term pa- tency in canine popliteal artery. Invest Radiol 4: 329-332

One of the first animal experimental papers on the feasibility of intravascular procedures.

Dotter CT, Buschmann RW, McKinney MR, Rosch J (1983) Transluminal expandible nitinol coil stent grafting:preliminary report. Radiology 147: 259-260

Early contribution to the subject of stenting by the father of interventional radiology.

Palmaz JC, Sibbitt PR, Reuter SR et al. (1985) Expandable intraluminal graft: preliminary study. Radiology 156: 73-77

Important early study on vascular stents

Sigwart U, Puel J, Mirkovitch V et al. (1987) Intravascular stents to prevent occlusion and restonosis after transluminal angioplasty. NEJM 316: 701-706

The first study on intracoronary stents

Cragg AH, Lund G, Rysavy JA et al. (1984) Percutaneous arterial grafting. Radiology 150: 45- 49

Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5: 491-499

Pioneering study on intraarterial stent repair of aortic aneurysm

Wallace MJ, Charnsangavej C, Ogawa K et al. (1986) Tracheo-bronchial tree: expandable metallic stents used in experimental and clinical applications. Work in progress.

Radiology 158: 309-312

Early report on tracheo-bronchial stents

Fabian KM (1980) Der intraprostatische “Partielle Katheter” (Urologische spirale). Urologe A19: 236-238

Early paper on intraprostatic stenting

Mobin-Uddin K, Smith PE, Martinez LO et al. (1967) A vena cava filter for the prevention of pulmonary embolus. Surg Forum 18: 209-211

Early paper on vena cava filters

Gianturco C, Anderson JH, Wallace S (1975) Mechanical devices for arterial occlusion. AJR 124: 428-435

One of the first reports of embolization as a means of treating bleeding vessels

Halasz NA, van Sonnenberg E (1987) Drainage of intra-abdominal abscesses. Tactics and choices. Am J Surg 146 (1): 112-5

Early studies of radiological techniques of abscess drainage

Strecker EP, Liermann DD, Berth KH et al. (1989) Expandable tubular tantalium stents for treatment of arterial occlusive disease with specific reference to the iliac arteries.

Radiology 173: 268

Early study on arterial stents in the peripheral vascular system.

Gunther RW, Vorwerk D, Bohndorf K et al. (1989) Iliac and femoral artery stenosis and occlusion- treatment with intravascular stents. Radiology 172: 725-30

A pioneering study on peripheral vascular stents

Nusbaum M, Baum S (1963) Radiographic demonstration of unknown sites of gastrointestinal bleeding. Surgical Forum 14: 374-375

Early description of selective arterial catheterisation to demonstrate bleeding.

Viamonte JR (1964) Selective bronchial arteriography in man – a preliminary report.

Radiology 830-839

First report of selective bronchial arteriography.

Baum S, Nusbaum M (1971) The control of gastrointestinal haemorrhage by selective mesenteric arterial infusion of vasopressin. Radiology 98: 497-505

First report on pharmacoangiography

Johnson AJ, McCarty WR (1959) The lysis of artificially induced intravascular clots in man by intravenous infusions of streptokinase. J Clin Investigation 38: 1627-1643

First description of intravenous thrombolysis

Dotter CT, Buschmann RW, McKinney MR, Rosch J (1983) Transluminal expandible nitinol coil stent grafting:preliminary report. Radiology 147: 259-260

Early contribution to the subject of stenting by the father of interventional radiology.

Introduction 435

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Cragg AH, Lund G, Rysavy JA et al. (1983) Nonsurgical placement of arterial endoprosthesis: a new technique using nitinol wire. Radiology 147: 261-263

Early paper on vascular stenting

Cragg AH, Lund G, Rysavy JA et al. (1984) Percutaneous arterial grafting. Radiology 150:

45-49

Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5: 491-499

Pioneering study on intraarterial stent repair of aortic aneurysms

Wallace MJ, Charnsangavej C, Ogawa K et al. (1986) Tracheo-bronchial tree: expandable metallic stents used in experimental and clinical applications. Work in progress.

Radiology 158: 309-312

Early report on tracheo-bronchial stents

Fabian KM (1980) Der intraprostatische “Partielle Katheter” (Urologische spirale). Urologe A19: 236-238

Early paper on intraprostatic stenting

Mobin-Uddin K, Smith PE, Martinez LO et al. (1967) A vena cava filter for the prevention of pulmonary embolus. Surg Forum 18: 209-211

Early paper on vena cava filters

Gianturco C, Anderson JH, Wallace S (1975) Mechanical devices for arterial occlusion. AJR 124: 428-435

One of the first reports of embolization as a means of treating bleeding vessels

Holm HH, Rasmussen SN, Kristensen JK (1973) Ultrasonically guided percutaneous puncture technique. Clinical Ultrasound 1: 27-31

Early paper on the use of ultrasound to guide interventional procedures

Smith EH, Bartrum RJ (1974) Ultrasonically guided percutaneous aspiration of abscesses.

AJR 122: 308-312

Early report of use of ultrasound to guide abscess drainage

Halasz NA, van Sonnenberg E (1987) Drainage of intra-abdominal abscesses. Tactics and choices. AM J Surg 146 (1): 112-115

Early studies of radiological techniques of abscess drainage

Haaga JR, Alfidi RJ (1976) Precise biopsy localisation by CT. Radiology 118: 603-607 One of the earliest reports of CT-guided biopsy

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Sven Ivar Seldinger

(1921–1998)

Sven-Ivar Seldinger was born in Mora, Sweden on 19 April 1921. He graduated in medicine from the Karolinska Institute in Sweden in 1948 and started his training in radiology in 1950. In 1953 he published his classic description of his percutaneous entry technique into arteries in the journal Acta Radiologica. The technique involved a thin-walled introducer needle and a wire and a plastic catheter. Using this particular technique it was possible to access any part of the body via the cardiovascular system. Dr Seldinger’s technique was important in that it enabled angiography to develop with superspecialization and techniques such as selective angiography and embolization became a possibility. The simplicity of Seldinger’s technique not only revolutionized cardiology but also enabled people to perform percutaneous transhepatic procedures and portal venography as well as using the technique to drain abscesses. It has found its use in urology and anesthesia and critical care medicine; central lines and pacemakers are all now put in using this particular technique. Seldinger’s thesis was entitled ‘Percutaneous transhepatic cholangiography’ and was defended in 1966. He catheterized the biliary ducts using his techniques. In 1967 he returned to Mora to become chief of the radiology department of the local hospital. It is interesting that the pioneering technique was not initially thought of as important.

His chief of the department of radiology at the Karolinska Institute, however, did not think that his invention of the new technique was enough for the basis of a thesis and this why he had to start his second project on the development of percutaneous cholangiography.

Herbert Abrahams wrote the following about Seldinger’s contributions:

“In the movement of angiography from the part of a bit-player to that of a pro- tagonist in the scenario diagnostic medicine, probably no single contribution has weighed more heavily than the technique developed by Sven Seldinger. To a major degree its elegance and its usefulness lie in its very simplicity and although Seldinger has been modest about his contribution, it took both ingenuity and cre- ativity to lead angiography into a new period and a new arena. All of us in radiology acknowledge our great debt to Seldinger for his vision. His contribution moved the field into a new and exciting direction and left a permanent imprint on medical imaging and diagnostic and therapeutic medicine.” Sven-Ivar Seldinger died in his home in Mora on 21 February 1998.

7.1 Catheter replacement of the needle in percutaneous arteriography: A new technique

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447

Willard E. Goodwin

(1916–1998)

Willard Goodwin was born on 22 July 1916. He graduated from the University of California at Berkeley and completed his medical studies at the Johns Hopkins Medical School. He trained in urology and joined the University of California at Los Angeles in 1951 and in 1953 became the founder and chief of urology. Here he built up an outstanding urology department and made numerous outstanding contributions to urology over the years, including his description of the technique of nephrostomy. He is credited with having made over 40 major innovations in urology and was one of the early pioneering renal transplant surgeons in the USA.

Willard Goodwin died in 1998.

Picture taken from http://www.urology.medsch.ucla.edu/history.html (12-03-04).

W.C. Casey W. Woolf

7.2 Percutaneous trocar (needle) nephrostomy in hydronephrosis

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452

F. Mason Sones

(1919–1985)

Dr Mason Sones was an early pioneering paediatric cardiologist who initially pioneered the use of image amplification in the fluoroscopic study of congenital heart defects. In 1959, however, he discovered that by using a catheter, contrast medium could be separately injected into the coronary arteries. Thus the first coronary angiogram was performed. Mason Sones used the brachial artery approach for coronary angiography and developed a vast expertise in this technique over his lifetime. He was awarded the Albert Lasker award in 1983 for his contributions to medical science. Mason Sones trained as a physician at the University of Maryland, qualifying in 1943. He spent most of his career in cardiology at the Cleveland clinic where his pioneering studies were carried out.

E.K. Shirey W.L. Proudfit R. Westcott

7.3 Cine coronary arteriography

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7.3 Cine coronary arteriography 453

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455

Alexander R. Margulis

(born 1921)

Margulis was born in the former Yugoslavia on 31 March 1921. After his secondary school education, he entered the University of Belgrade, Faculty of Medicine, in 1939, and finished his medical education at the Harvard Medical School in Boston, where he graduated in 1950. From 1950 to 1951, he was intern at the Henry Ford Hospital, and from 1951 to 1954 resident and clinical instructor at the University of Michigan Hospital. He has held a California Medical License since 1963 and a diploma from The American Board of Radiology since 1954.

Professor Margulis served as Captain in the U.S. Army Medical Corps from 1957 to 1959, was instructor and assistant professor at the University of Minnesota Hospitals from 1954 to 1957, associate professor and full professor at the Washington University in St. Louis from 1959 to 1963, and has since been professor and associate chancellor at the University of California in San Francisco. During this last permanent appointment, he has held ancillary positions as consultant, di- rector or chairman at more than a dozen medical or scientific institutes and hospitals. It is worth mentioning his post as associate chancellor and founding direc- tor of the Magnetic Resonance Science Center at UCSF.

He has authored numerous books, chapters, papers and abstracts including the classic gastrointestinal radiology textbook.

Professor Margulis has been a permanent member of many radiological societies, an honorary member of a number of international radiological societies, including the European Congress of Radiology since 1993, and since 1966 has taken part as member, chairman, co-founder, president, etc. in more than forty profes- sional organisations.

Professor Margulis has received several honorary degrees from prominent U.S.

and European medical or scientific institutes and has won more than twelve awards and medals from U.S. and European radiological institutes.

Taken in part from www.ecr.org.

P. Heinbecker

7.4 Mesenteric Arteriography

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Charles T. Dotter

(1920–1985)

Charles Dotter was born in Boston on 14 June 1920. He received a Bachelor of Arts degree in 1941 from Duke University. He then proceeded to study medicine at Cornell University. He completed his internship in the United States Naval Hospital in New York State and his residency at New York Hospital. At the age of 30 he became a full-time faculty member at Cornell Medical School. Two years later he became professor and Chairman of the Department of Radiology at the University of Oregon Medical School. He was only 32 years of age and was appar- ently the youngest person to have ever been made chairman of a radiology department in a major American medical school. He stayed at Oregon for 32 years.

He is rightly considered the father of interventional radiology, publishing more than 300 papers, of which he was the first author on more than half. He is credited with performing the first transluminal angioplasty. His trainee for the first procedure was Melvin Judkins, who also went on to become a great angiography pio- neer. The first patient to benefit from angioplasty was Laura Shaw, an 82-year-old woman who was admitted to the University of Oregon Hospital with a painful left foot. Her pain disappeared a week following the angioplasty and her ulcers soon healed. Dotter invented the balloon catheter and used it to study circulation. He also made contributions to forensic pathology, publishing a case report in 1961 entitled “Murder by Suffocation” in which dental radiography and photography was used to make a diagnosis. He even published an article on cardiac resuscitation in 1962 and was considerably ahead of his time. As a human being he was a poly- math. He was a pilot, a flyer and a mountain climber. He was interested in classical music, painting, photography and outdoor living. He was nominated for the Nobel Prize in medicine in 1978 and his pioneering research into interventional radiology resulted in 4 gold medals. He passed away in 1985.

Melvin P. Judkins

(1922–1985)

An associate of Dr. Charles Dotter at the University of Oregon in Portland, radiol- ogist Dr. Melvin Judkins studied coronary angiography with Dr. Mason Sones.

Judkins went on to create his own system of diagnostic imaging, introducing a series of specialized catheters and perfecting the transfemoral approach (introducing the catheter via a groin puncture rather than the more complex procedure used by Sones of introducing the catheter via surgical opening of the brachial artery in the arm).

A careful perfectionist, Judkins went to great lengths to educate his patients, train his colleagues and share his techniques, and continued his work at Loma Linda Medical Center. Judkins furthered the goal of an accessible, systematic approach to high-quality diagnostic radiology. The Judkins technique of coronary angiography remains the primary diagnostic tool used in catheterization labora- tories around the world.

7.5 Transluminal treatment of arteriosclerotic obstruction:

description of a new technique and a preliminary report of its application

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Melvin P. Judkins

(1922–1985) see Chapter 7.5 on page 467

7.6 Selective coronary arteriography

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H. Joachim Burhenne

(1925–1996)

Dr Burhenne was born in Hannover in Germany in 1925. His medical qualification was from the University of Munich. He moved to the United States in 1959 and did his residency training in Radiology at the Peter Bent Brigham and other Boston hospitals. He was an instructor in Radiology at Harvard and conducted a research fellowship at the National Hospital for Nervous Diseases in Queen Square, London. He also worked at the University of California as a Professor until he moved to the University of British Columbia in Vancouver, Canada in 1978. He was the author of the definitive textbook “Abdominal Radiology”, which he co-authored with Dr Alex Margulis. Dr Burhenne’s contribution to gastro-intestinal radiology is well documented. He became President of the International Biliary Society as well as President of the San Francisco and California Radiological Society and the President of the Society of Gastro-intestinal Radiologists. He received many awards, including the gold medal of the American Roentgen Ray Society, and was an honorary member of 4 surgical organisations including an honorary degree from the Royal College of Surgeons of Ireland. Dr Burhenne was an award-winning photographer, an accomplished violinist and also published a book on ski touring. He passed away on 1 June 1996.

7.7 Non-operative retained biliary tract stone extraction.

A new roentgenologic technique

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509

Andreas R. Grüntzig

(1939–1985) see Chapter 7.9 on page 514

H. Hopff

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Andreas R. Grüntzig

(1939–1985)

Andreas Gruentzig was born in Dresden, Germany in 1939. He completed his for- mal education in Heidelberg. He graduated in medicine in 1964 from Heidelberg and completed the rotating internship by research in epidemiology. It was at that time that he developed his interest in coronary artery disease. He trained in the Ratchow clinic in Darmstadt, Germany. He moved to Zurich as a fellow of Dr Bolanger and in the angiology department he demonstrated his inventive techniques by developing a method to measure the one-half relaxation time of the Achilles’ tendon reflex produced by electrical stimulation to evaluate ischemic limbs. He then moved to the department of radiology and visited Dr Zeitler in Frankfurt to observe the Dotter method. He introduced this method at the University of Zurich. An early demonstration of the technique of angioplasty resulted in the entire plaque embolizing into the popliteal artery. This resulted in radiologists becoming very sceptical of this new technique. He nevertheless persist- ed, like all great pioneers, and with the help of Dr Ake Senning, chief of cardiovascular surgery and Dr Walter Siegenthaler, chief of medicine he eventually managed to collect a small series of Dotter cases, working mostly during the lunch break while he was a full-time fellow in internal medicine. Gruentzig had heard of the ideas of Porstmann, who had placed a latex balloon in the slotted angiograph- ic catheter. He worked evenings in his kitchen with his wife, Michaela, his assistant, Maria Schlumpf and her husband Walter. They designed many versions of the balloon catheter, which they built with bits of rubber thread in epoxy glue. A double-lumen catheter was first used in the iliac artery on 23 January 1975. The success of this method resulted in him wondering whether this technique could be used in the coronary arteries. His first attempts to dilate the coronary arteries were first performed in dogs on 24 September 1975. In 1976 Andreas Gruentzig visited the United States for the first time to present his experiments in the poster session of the 49th scientific session of the American Heart Association in Miami Beach. This exhibit was greeted with great interest. On 16 September the first procedure of coronary angioplasty was performed. The vessel remained patent with- out re-stenosis. Soon afterwards Dr Gruentzig had collected enough data to pub- lish an important paper in the New England Journal of Medicine on this technique.

Today the technique has become routine. Unfortunately Dr Gruentzig died in an air crash in 1985.

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Peter R. Mueller

(born 1947)

Peter Mueller was born in Boston, Massachusetts on 20 June 1947. He received his BA from Harvard University, Cambridge, MA in 1969 and his MD, University of Cincinnati Medical School, Cincinnati, Ohio in 1973.

He started his Medical Internship in 1973 at Cincinnati General Hospital, Cincinnati and became Radiology Resident, Massachusetts General Hospital, Boston between 1974–1977. He became Instructor in Radiology (1977–1981), Assistant Professor of Radiology (1981–1984), Associate Professor of Radiology (1984–1999) and in 1999 he was appointed Professor of Radiology at Harvard Medical School, Boston and subsequently Division Head, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston.

Mueller is Fellow, American College of Radiology (1991), Honorary Fellow, The Royal College of Radiologists, London, England (1995), Honorary Fellow, Royal College of Surgeons in Ireland, Dublin, Ireland (1998). In 1993 he was appointed President of the Society for Minimally Invasive Therapy (SMIT). In 1994 he became Secretary of the Society of Hepato-biliary Radiology. In 1998-1999 he was President of the New England Roentgen Ray Society. He has published more than 300 scientific papers, 288 abstract presentations, 54 book chapters, and three textbooks.

Peter Mueller’s early and main area of research was in the evaluation and development of non-vascular interventional techniques. Over the past 20 years his division has introduced or refined a number of interventional procedures. Early in his career most of the papers were analyses of interventional procedures in the biliary tree. These included a number of papers which described techniques for percutaneous treatment of benign and malignant biliary obstruction.

In addition, he and his colleagues, including Eric van Sonnenberg, introduced percutaneous drainage procedures of fluid collections and abscesses to the Massachusetts General Hospital. Techniques and procedures first developed at the MGH have been taught nationally and world wide through papers and lectures and are now standards of care. Although his first area of interest is abdominal radiology, he has introduced interventional techniques to other anatomic areas such as the pleural space. Drainage procedures of the pleural space are now used worldwide.

Throughout his career he has always tried to find innovative methods for deal- ing with interventional problems. Mueller helped develop a patented method for performing percutaneous gastrostomy as an alternative to either surgical or endo- scopic placement of gastrostromy tubes. This method is essentially a percutaneous method for placing a tube that is analogous to that used by surgeons. He also was involved in the development of a metallic needle which can be used in magnetic resonance imaging.

More recently Mueller has been the point person for the use of alcohol and ra- diofrequency ablation of liver tumors and treatment of benign prostatic hypertro- phy. Recent articles in his CV reflect both his laboratory work and clinical application of these methods. Both programs represent successful clinical methods of treatment of malignant tumors of the liver.

Picture courtesy Peter Mueller, MD, 2004.

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Eric van Sonnenberg

Eric vanSonnenberg got his Bachelor of Science in Zoology in 1968 from George Washington University, Washington, D.C. and his medical degree from University of Cincinnati, School of Medicine, Cincinnati, Ohio in 1973. At the New York Medical Colllege, Metropolitan Hospital he started his internship in surgery (rotating) in 1973 and became resident (1974) and chief resident (1976) in internal medicine. In 1976 van Sonnenberg started his residency in diagnostic radiology at Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Here he became fellow (1976–1979) in CT, Ultrasound, GI, and Interventional Radiology, Clinical Fellow (1979–1980) and Instructor in Radiology (1980–1981).

He went to the University of California, San Diego and became Assistant Professor of Radiology (1981–1984), Associate Professor in Residence in Radiology and Medicine (1984–1989) and Professor in Residence, Radiology and Medicine (1989–1993). In 1993 van Sonnenberg was appointed Chairman and Professor of Radiology and Professor of Internal Medicine and Surgery at the University of Texas Medical Branch, Galveston, Texas. He was appointed Chief of Radiology at the Dana Farber Cancer Institute (2000) and Consultant Interventional Radio- logist at the Children’s Hospital of Boston (2002) at Harvard Medical School, Boston, Massachusetts. Since 1999 he has been Visiting Professor of Radiology at the Brigham and Women’s Hospital, Harvard Medical School, Boston, Massa- chusetts.

Eric van Sonnenberg is a member of several national and international scientific societies. Among them the Radiological Society of North America (RSNA), American Roentgen Ray Society (ARR), Society of Gastrointestinal Radiology (SGR), American Institute of Ultrasound in Medicine (AUM), International Society of Hepato-Biliary Pancreatic Radiology (ISHBPR), American College of Radiology (ACR), International College of Surgeons, European Society of Interventional Radiology (2003). He is a reviewer and editor of several scientific journals. He has published 257 original papers, 96 books and chapters, 344 scientific abstracts, and presented 1194 lectures.

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Julio C. Palmaz

Dr Palmaz is credited as being one of the early pioneers of intravascular stent therapy, which has revolutionized the way patients are treated for arterial block- ages. He is currently a professor of interventional radiology at the University of Texas Health Science Centre at SanAntonio. He is the author of numerous papers and presentations on vascular radiology topics and has been the recipient of several awards and honors.

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Ulrich Sigwart

(born 1941)

Ulrich Sigwart has been credited with the concept and development of endolumi- nal stenting. Stents have fundamentally changed the treatment of cardiovascular diseases and have become the most important treatment of coronary and extra- coronary arterial disease. This work has resulted in a number of prizes including, the Medal of the European Society of Cardiology and an Honorary Doctorate of the University of Lausanne.

He also conceived and pioneered non-surgical myocardial reduction therapy, which has now become an accepted and widely used treatment of hypertrophic obstructive cardiomyopathy. Questions relating to this technique are now part of the written exams for the American Board of Cardiology.

Furthermore, his work on automation on cardiac catheterization carried out during the years 1974–1978 was the basis for the present day use of computers in hemodynamic evaluation. The sequence of events in myocardial ischemia (Sigwart curve) has found its way into numerous textbooks and is one of the most quoted illustrations. Ulrich Sigwart made fundamental observations on prosthetic heart valves that led to major modifications of the previously used designs.

Prof. Sigwart was born on 9 March 1941. He went to the medical schools of the uni- versities of Freiburg (Germany), Basel (Switzerland) and Münster (Germany). In 1967 he gained his MD from the University of Freiburg (“magna cum laude”). In February 1985 we was appointed Professor of Medicine at the University of Duesseldorf. Since 1989 he has been an Associate Professor of Cardiology at the University of Lausanne and a Recognised Teacher at the Imperial College of Medicine, London. In 2001 he was appointed Professor of Cardiology at the University of Geneva (Switzerland).

Ulrich Sigwart is a Fellow, American College of Cardiology, American College of Angiology, Royal College of Physicians, The Bromptonian Society, and an Honorary Fellow of the Russian Society of Interventional Cardioangiology, Founding Fellow, European Society of Cardiology (Past Chairman, Working Group Myocardial Function). Furthermore, Prof. Sigwart is a member of several national and international scientific societies. Among other awards Sigwart was awarded the European Society of Cardiology Medal (1996), the ESC Grüntzig Award (1996), the Doctor honoris causa, University of Lausanne (1999), the Forssmann Prize (2001), the Sven Effert Prize (2003) and the King Faisal International Prize for Medicine (2004).

He is serving on the editorial board of several medical journals, e.g., the Journal of the American College of Cardiology, Clinical Cardiology, International Journal of Cardiovascular Interventions, Cardiology International, British Journal of Cardiology. He has published more than 500 separate publications and 7 books.

Ulrich Sigwart presently holds the Chair of Cardiology at Geneva University and directs the Centre of Cardiology. He keeps some activity at the Royal Brompton Hospital, where he headed the Department of Invasive Cardiology for more than twelve years.

Picture courtesy Ulrich Sigwart, MD, 2004.

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