1
`
`A Tribute
`Seldinger
`
`to Sven-Ivar
`
`is a
`so it
`up with,
`we grew
`things
`life without
`to imagine
`impossible
`is almost
`It
`the
`about
`heard
`they
`first
`when
`the thrill
`of angiographers
`hard
`for us to feel
`little
`even
`guess
`how angiog-
`cannot
`Seldinger
`technique
`[1]. Present-day
`radiologists
`to this method
`that we
`so used
`raphy
`could
`have
`been
`done
`without
`it. We are
`have
`begun
`dropping
`the eponym,
`as it has become
`the “natural”
`way
`to insert
`the
`catheter
`in a blood
`vessel.
`But
`let us recount
`the circumstances
`under
`which
`the
`technique
`was
`conceived.
`began
`artery
`and the pulmonary
`atrium and ventricle
`right
`Catheterization
`of
`the
`of Cournand
`on the basis
`of
`the extensive
`experience
`to be practiced
`in the
`1940s
`reluctance.
`at
`that
`time was
`accepted
`with
`some
`and Richards
`[2]. Arteriography
`Peripheral
`arteries
`such
`as the femoral
`and
`carotid,
`easy
`to reach,
`were
`injected
`through
`needles.
`The aorta
`and its branches
`were
`visualized
`by direct
`needle
`stick,
`[31 in 1 931 . The
`of
`as described
`by Dos Santos
`et al.
`finer
`details
`the
`visceral
`arteries,
`the
`thoracic
`and
`ascending
`aorta,
`and
`the
`aortic
`arch were
`still
`beyond
`reach.
`Efforts
`to extend
`that
`reach
`with
`a catheter
`instead
`of a needle
`were
`few
`[4].
`through
`into the aorta
`catheters
`Fari#{241}asintroduced
`radiologist
`the Cuban
`In 1 940,
`artery. When
`Fari#{241}aspresented
`exposed
`femoral
`a trocar
`placed
`in the surgically
`Roentgen
`Ray Society
`in Boston
`of
`the American
`his findings
`at
`the annual meeting
`Dr. Sidney
`Burwell
`commented,
`“I cannot
`per-
`in 1 941 , amid widespread
`praise,
`the
`femoral
`artery
`and
`the
`introduction
`of
`a
`of
`suade
`myself
`that
`the
`incision
`or one without
`hazard”
`[5]. Although
`the Society
`catheter
`is a small
`procedure
`Gold Medal
`the following
`year,
`the medical
`profession
`awarded
`Fari#{241}asits coveted
`was
`reluctant
`to use
`his method.
`Fari#{241}ashimself
`abandoned
`this
`approach;
`in a
`paper
`published
`in 1 946,
`he blamed
`“the difficulty
`due to war
`conditions
`in obtaining
`rubber
`catheters”
`[6].
`surgical
`but
`difticulties,
`great
`World War
`II created
`coarctation
`arteriosus,
`ductus
`management
`of patent
`advances
`from radiology.
`corresponding
`technical
`the few corners
`of
`the medically
`advanced
`world
`were
`able
`to pursue
`questions
`of how to opacify
`arch.
`In the late
`1940s,
`Radner
`[7]
`in Lund
`thought
`the
`ascending
`aorta
`through
`a catheter
`introduced
`then
`be advanced
`into the brachial
`and subclavian
`But
`this
`still
`involved
`cutting
`into an artery,
`with
`or scarring
`and thus
`narrowing
`the lumen
`[8].
`a
`through
`material
`contrast
`injected
`In the United
`States,
`Freeman
`and Miller
`[9]
`and
`vision
`direct
`still
`under
`but
`needle
`inserted
`in the
`common
`carotid
`artery,
`approach,
`similar
`a somewhat
`surgical
`cut-down.
`JOnsson
`[8]
`in Stockholm
`used
`into the
`needles
`but added
`a new element
`to the procedure:
`He introduced
`coaxial
`common
`carotid,
`directing
`them downward.
`After
`the
`inner,
`thinner
`needle
`was
`removed,
`a silver
`thread
`was
`inserted
`into
`the
`outer
`cannula,
`which
`had
`a blunt
`
`(e.g.,
`were made
`advances
`the aorta) which
`demanded
`of
`Radiologists
`in Sweden,
`one of
`that
`escaped
`the ravages
`of war,
`the
`ascending
`aorta
`and
`aortic
`it would
`be practical
`to opacify
`via the
`radial
`artery.
`It might
`arteries
`and finally
`into the arch.
`the concomitant
`risk of
`thrombosis
`
`T. Doby1
`
`Sel-
`of
`
`ago, Sven-lvar
`30 years
`over
`Just
`simple
`method
`described
`a
`dinger
`percutaneously.
`introducing
`a catheter
`The
`radiology.
`which
`has
`revolutionized
`this anniversary
`AJR is privileged
`to note
`while Dr. Seldinger
`is still actively
`practic-
`ing in a small
`city north
`of Stockholm.
`Melvin M. Figley
`Editor
`
`after
`
`re-
`
`28, 1983; accepted
`
`Received January
`vision
`July
`13, 1983.
`Mercy Hospital,
`1 Department
`of Radiology.
`reprint
`requests
`land, ME 04101.
`Address
`Cottage
`Lane, Cape
`Elizabeth,
`ME 04107.
`AJR 142:1-3,
`January
`1984
`0361 -803X/84/1
`421-0001
`© American
`Roentgen
`Ray Society
`
`Port-
`to
`22
`
`University of Maryland, Baltimore
`IPR2016-00208
`
`Exhibit 2010
`Page 1 of 3
`
`

`
`2
`
`SELDINGER
`
`TRIBUTE
`
`AJR:142.
`
`January
`
`1984
`
`the
`past
`forward,
`carefully
`pushed
`was
`thread
`end. The silver
`In JOns-
`the
`aorta.
`and
`into
`arteries
`carotid
`and
`innominate
`the thread
`as a guide
`the cannula
`is
`son’s
`description,
`“Using
`that
`its tip comes
`inside
`the aortic
`then
`pushed
`down
`so far
`arch. When
`a guide
`of
`this
`kind
`is used
`there
`is no risk
`of
`injury
`to the
`arterial
`wall.
`The
`thread
`is very
`soft
`and
`has
`a
`rounded
`tip and
`cannot
`do any damage
`if
`it
`is pushed
`slowly
`and
`gently”
`[8].
`Injection
`took
`place
`after withdrawal
`of
`the
`silver
`thread.
`Despite
`assurances
`of safety,
`the method
`was
`not without
`danger
`and failed
`to gain
`popularity.
`in the United
`In 1 951 , 1 0 years
`after
`Fari#{241}as,Peirce
`[1 2]
`States
`returned
`to the femoral
`artery,
`but
`this time
`he inserted
`a polyethylene
`tube
`through
`a needle
`percutaneously.
`Others
`continued
`resort
`to
`surgical
`cutdown,
`whether
`of
`the
`to
`femoral
`[1 0] or a branch
`the profunda
`femoris
`[1 1].
`artery
`of
`Peirce’s
`percutaneous
`method
`was
`innovative
`but
`far
`from
`ideal,
`because
`the tube was
`not
`radiopaque
`and the end of
`was
`rigid
`and
`could
`not
`be
`directed
`[12].
`Adventuresome
`researchers
`attempted
`to overcome
`these
`difficulties:
`Euler
`[13]
`in Germany
`injected
`the aortic
`arch
`through
`the esopha-
`gus,
`using
`an esophagoscope;
`in Cuba,
`Ponsdomenech
`and
`Beato-Nu#{241}ez [14]
`introduced
`contrast
`material
`directly
`into
`the right
`and
`left
`ventricles
`by percutaneous
`puncture.
`They
`reported
`56 cases
`without
`fatality
`[1 4], but
`the method-not
`surprisingly-did
`not become
`popular.
`Many
`1950s.
`early
`the
`This
`was
`state
`of affairs
`in the
`a method
`to
`but
`sensed
`the great
`potential
`of angiography,
`was
`lacking.
`avoid
`surgical
`placement
`of
`suitable
`catheters
`Then
`an enterprising
`young
`radiologist
`at
`the Karolinska
`In-
`stitute
`in Stockholm-inspired
`perhaps
`by the one-year
`sur-
`gical
`residency
`that
`is a part of
`the Swedish
`radiology
`training
`program-came
`up with
`the solution.
`the end of
`into
`Dr. Seldinger
`thought
`he could
`fit a needle
`the catheter
`a catheter
`through
`a side
`hole,
`thus
`introducing
`“the catheter
`and removing
`the needle
`afterward.
`But because
`further
`into
`the
`not
`often
`was
`rigid
`enough
`to be advanced
`vessel
`without
`support,
`[he]
`added
`to the equipment
`a guide
`wire
`essentially
`of
`the same
`type
`that
`is still
`in common
`use”
`(Seldinger
`SI, personal
`communication,
`1976). However,
`the
`possible
`risks
`of
`retention
`of
`the metal
`tip
`of
`the wire
`or
`rupture
`of
`the
`catheter
`the
`side
`hole were
`dangers
`that
`could
`not be disregarded.
`Then,
`“once
`after
`an unsuccessful
`attempt
`of using
`that
`technique,”
`as he recounts,
`“I stood
`the lab quite
`sad with
`the three
`items
`in my hand:
`the needle,
`the guide wire
`and the catheter;
`and suddenly
`I was
`aware
`of
`how they
`should
`be properly
`used
`(fig. 1). So if you put
`it
`that
`way,
`the time
`consumed
`for
`the invention
`was
`approximately
`one second”
`(Seldinger
`SI, personal
`communication,
`1976).
`a
`The
`solution
`seems
`simple
`now:
`A needle
`is introduced,
`The
`guide
`wire
`is pushed
`into
`it, and the needle
`is removed.
`catheter
`then
`is guided
`in over
`the wire, which
`also is removed
`[1].
`The
`procedure
`was
`developed
`further
`in Sweden
`and
`adopted
`immediately
`in the United
`States,
`Europe,
`and Japan.
`Within
`a few years,
`the
`vascular
`supply
`of
`the
`abdominal
`organs
`was mapped
`out
`by Seldinger
`[15,
`16]
`and
`others,
`mainly
`Odman
`[17],
`also
`of Stockholm.
`Initially,
`to visualize
`the
`nonopaque
`catheter,
`Seldinger
`filled
`it with
`diodrast.
`little
`later
`(1956),
`Odman
`arranged
`for
`the
`production
`
`in
`
`A
`of
`
`it
`
`at
`
`.iVd(cid:1).
`
`(cid:1),i
`
`AD/e
`
`‘1’
`
`v(cid:1)(cid:1)A-(cid:1)r’(cid:1)4’
`
`/
`
`.(cid:1)s(cid:1):’(cid:1),’c”
`,r,,4,
`
`(cid:1),
`
`/1o/c?
`
`(cid:1)v
`
`(cid:1) (cid:1)
`
`....r/re’/eA_.2.
`
`Fig. 1 .-Seldinger’s
`introducing
`catheter
`
`of
`
`line drawing
`into artery.
`
`two stages
`of
`(Reproduced
`
`of his method
`in development
`from letter
`to T. Doby,
`1976.)
`
`experiments
`In his model
`by a company.
`catheters
`radiopaque
`into
`molded
`used
`catheters
`with
`cadavers,
`Seldinger
`already
`the required
`shape-many
`of
`them having
`the same
`curvature
`At
`as
`those
`used
`today.
`that
`time
`there
`were
`no cassette
`changers;
`he used
`a wooden
`tunnel
`to hold
`three
`cassettes,
`no
`which
`were
`hand-pulled
`after
`each
`exposure.
`There
`was
`television,
`no image
`amplification,
`and
`no angiography
`table.
`The
`success
`of his
`first
`great
`scientific
`achievement
`led
`Seldinger
`to explore
`other
`areas
`of diagnostic
`and
`interven-
`tional
`radiology.
`He described
`catheterization
`of
`the
`spleen
`and
`liver
`[18],
`and
`published
`pressure
`readings
`in the
`portal
`vein
`in pathologic
`conditions
`and
`after
`administration
`of var-
`ious
`chemical
`compounds
`[1 9, 20].
`He
`pioneered
`percuta-
`[21 ] and wrote
`neous
`transhepatic
`cholangiography
`on pan-
`creatic
`diagnostics
`[22],
`vascular
`anomalies
`in the extremities
`other
`topics.
`But
`despite
`the
`importance
`of
`these
`[23],
`and
`later
`investigations,
`his very
`first
`article
`on catheter
`placement
`was
`the one that
`opened
`a whole
`new chapter
`in medicine.
`In 1 956,
`the
`coveted
`Nobel
`Prize was
`awarded
`to Cour-
`nand,
`Forssmann,
`and Richards
`“for
`their
`discoveries
`con-
`cerning
`heart
`catheterization
`and pathological
`changes
`in the
`circulatory
`system”
`[24].
`Cardiovascular
`catheterization
`had
`finally
`been accepted
`by the medical
`profession
`and the public.
`of
`This method,
`especially
`in the
`arterial
`side
`the
`circulation,
`was
`developed
`to its full extent
`only
`by the Seldinger
`tech-
`nique
`[1], which
`enabled
`hundreds
`of
`investigators
`to achieve
`surprisingly
`successful
`results
`in diagnostics
`and
`therapy
`[25].
`But
`30 years
`ago,
`to quote
`the man whose
`discovery
`made
`such
`advancements
`possible,
`“nobody
`at
`that
`stage
`
`University of Maryland, Baltimore
`IPR2016-00208
`
`Exhibit 2010
`Page 2 of 3
`
`

`
`AJR:142.
`
`January
`
`1984
`
`SELDINGER
`
`TRIBUTE
`
`3
`
`it should
`of applications
`the multitude
`dream about
`could
`to”
`(Seldinger
`SI, personal
`communication,
`1976).
`
`lead
`
`REFERENCES
`
`of
`replacement
`new
`technique).
`
`the needle in percutaneous
`Acta
`Radiol
`(Stockh)
`
`catheterization.
`
`Acta Med Scand
`
`[Suppl]
`
`1 . Seldinger SI. Catheter
`arteriography
`(a
`1953:39 :368-376
`2. Cournand
`A. Cardiac
`1975;579:
`1-35
`JP. Art#{233}riographie des
`AC, Caldas
`3. Dos Santos
`R, Lamas
`Paris: Masson
`et Cie, 1931
`membres
`et de
`I’aorte
`abdominale.
`4. Cunningham JJ, Thurber B. The abdominal
`aortogram:
`an historic
`AJR 1972;1
`16:441-444
`perspective.
`examination
`the arteriographic
`5. Fari#{241}asPL. A new technique
`for
`AJR 1941;46:641-645
`of
`the
`abdominal
`aorta
`and
`its branches.
`6. Fari#{241}asPL. Retrograde
`abdominal
`aortography.
`Radiology
`1946;47 :344-348
`aortography
`7. Radner S. Thoracal
`(Stockh)
`1948:29:179-180
`8. JOnsson G. Thoracic
`aortography
`(Stockh)
`1949:31 :376-386
`Aadiol
`in diagnosis
`arteriography
`9. Freeman NE, Miller ER. Retrograde
`cardiovascular
`lesions. Ann Intern Med
`1949;30 :330
`10. Helmsworth
`JA, McGuire
`J, Felson B. Arteriography
`and its branches
`by means
`of
`the polyethylene
`1950:64:196-213
`11. Goodwin WE, Scardino PL, Scott WW. Translumbar
`ture
`and
`retrograde
`catheterization
`of
`the
`aorta.
`1950;1 32:944-958
`12. Peirce EC. Percutaneous
`with
`special
`reference
`
`by catheterization.
`
`Acta Radiol
`
`by means of a cannula.
`
`Acta
`
`of
`
`the aorta
`of
`catheter.
`AJR
`
`aortic punc-
`Ann
`Surg
`
`femoral
`artery
`to aortography.
`
`catheterization
`Surg
`Gynecol
`
`in man
`Obstet
`
`1951;93 :56-74
`13. Euler HE. Die peroesophagale
`sen Kehlk
`1949;155:536-567
`V. Heart puncture
`14. Ponsdomenech
`ER, Beato-Nunez
`diodrast
`visualization
`of
`the ventricular
`chambers
`J 1951:41 :643-650
`arteries.
`Am Heart
`adenomata
`1 5. Seldinger
`SI. Localization
`of parathyroid
`ography.
`:353-366
`Acta Radio!
`(Stockh)
`1954:42
`16. Seldinger
`SI. Percutaneous
`catheterization
`of
`1956:45:15-20
`Acta Radio!
`the
`of
`angiography
`selective
`Odman
`P.
`Percutaneous
`branches
`of
`the aorta. Acta Radio!(Stockh)
`1956:45:1-14
`1 8. Seldinger
`SI. A simple method
`of catheterization
`of
`the spleen
`and liver. Acta Radio!
`(Stockh)
`1957;48:93-96
`19. Seldinger SI, Amer 0, Hagberg S, Sundblad R. Measurement
`pressure
`by percutaneous
`transhepatic
`puncture.
`portal
`1965:130:206-212
`Chir Scand
`S, Sundblad
`20. Seldinger
`SI, Amer 0, Hagberg
`pressure
`on portal
`ylalanin-lysin-vasopressin
`by
`percutaneous
`transhepatic
`puncture.
`1965:130:213-215
`transhepatic
`21. Seldinger
`SI. Percutaneous
`Radio! [Supp!] (Stockh)
`1966:253
`22. Seldinger
`reflux
`SI, Bergkvist
`A. Pancreatic
`to pre- and postoperative
`giography
`in relation
`Acta Chir Scand
`tion.
`1957:114:191-196
`Seldinger
`SI. Arteriography
`of
`the
`1961:29:47-54
`and physiology.
`Nobe! Prize winners in medicine
`Sourkes
`TL.
`1966
`York,
`Toronto:
`Ab#{233}lard-Schuman,
`London,
`New
`25. Doby T. Development
`of angiography
`and cardiovascular
`terization.
`1976
`Littleton,
`MA:
`John Wright-PSG,
`
`Aortenpunktion.
`
`Arch Ohren
`
`Na-
`
`in man for
`and
`great
`
`by arteri-
`
`the renal artery.
`
`main
`
`of
`Acta
`
`R. Effect of phen-
`in man as measured
`Acta
`Chir
`Scand
`
`cholangiography.
`
`Acta
`
`in operative
`pancreatic
`
`cholan-
`affec-
`
`extremities.
`
`Postgrad
`
`Med
`
`cathe-
`
`17.
`
`23.
`
`24.
`
`University of Maryland, Baltimore
`IPR2016-00208
`
`Exhibit 2010
`Page 3 of 3