By: Jean Johnson for Veins1
Despite a five-plus-year success rate using uterine fibroid embolization or UFE to treat uterine fibroids, interventional radiology – or plain old IR as those in the business often call it – has yet to become a household word. Americans may let things like MRI, CAT scan and even angioplasty role off their tongues without so much as a backward glance, but should the conversation slip into the realm of IR-speak, eyes can narrow and chins will tend to raise some.
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| The Evolution of IR Technology
3000 B.C. - Egypt - bladder catheterizations were performed with ultra-thin metal pipes.
400 B.C. - Scientists are using catheters fashioned from hollow reeds and pipes to study the function of cardiac valves.
1711 A.D. - The first cardiac catheterization of a horse using brass pipes, a glass tube, and the trachea of a goose is conducted.
1844 - French physiologist employs catheters to record intra-cardiac pressures in animals.
1929 - The first human cardiac catheterization performed by Werner Forssmann, M.D. in Germany.
1941 - Columbia’s André Cournand and Dickinson Richards used the cardiac catheter as a diagnostic tool.
1958 - Mason Sones, M.D., stumbles upon potential new techniques for producing high quality diagnostic images of the coronary arteries.
1964 - Charles Dotter, M.D. and Melvin Judkins, M.D., open blocked arteries and improve blood flow in patients with arteriosclerosis in peripheral (leg) arteries.
While interventional cardiologists, the IR counterparts, have been quite successful in convincing the public that many types of heart disease can be treated without resorting to the surgeon’s scalpel, interventional radiologists have not yet enjoyed similar acceptance in not only the area of UFE, but also other types of medical treatments such as those recommended for varicose veins.
A look back at the history of IR does much to explain why this is the case. Indeed, the new kid on the block has been a long time coming and experienced many growing pains in its pioneering work to alleviate symptoms without surgery.
IR – or treating medical problems by inserting thin catheters in the body’s tubular structures including arteries, ureters, and bile ducts – all started in Egypt back in 3000 B.C. There in the world of papyrus scrolls and libraries of information, bladder catheterizations were performed with ultra-thin metal pipes. Since then, we’ve come a long way baby!
It probably stands to reason that the heart – not the uterus – was the first stop off for scientists exploring the terrain of treating problems of the interior body by threading catheters to the sites instead of using scalpels for dissection. What could be more central to life but the pulsing, rhythmic engine working on its own accord, ticking away within the center of our chests?
Interventional work inched along over the next 1500 years or so to 400 B.C., by which time scientists were using catheters fashioned from hollow reeds and pipes to study the function of cardiac valves. Another couple millennia was all it took for researchers to start really cranking during the Scientific Revolution.
In 1711 the first cardiac catheterization of a horse using brass pipes, a glass tube, and the trachea of a goose was conducted. Merely a century later in 1844, a French physiologist coined the term “cardiac catheterization” and was employing catheters to record intra-cardiac pressures in animals.
All that work paved the way for the first documented human cardiac catheterization performed in 1929 by Werner Forssmann, M.D. of Eberswalde, Germany. The Americans at Columbia University in New York took due note of Forssmann on the other side of the Atlantic, and in 1941 Columbia’s André Cournand and Dickinson Richards used the cardiac catheter as a diagnostic tool for the first time.
The scientific community was so stunned that physicians had used catheter techniques to measure the output of the heart, that it awarded Forssmann, Cournand, and Richards a Nobel Prize in 1956. “The cardiac catheter,” Cournand said, “was the key in the lock.”
They don’t give out Nobel Prizes lightly, of course, and it was in the wake of these major discoveries that things started getting exceptionally interesting, with the first major break through coming quite by accident.
The place and date: The Cleveland Clinic, 1958.
The patient: A small child with heart valve problems.
The physician: Pediatric cardiologist Mason Sones, M.D.
Sones was conducting an imaging procedure in which dye was to be injected into the aortic valve. Instead, the physician accidentally threaded the catheter into the patient’s right coronary artery. Before he could correct the error, the team released a good amount of the contrast dye. Sones expected the child’s heart to fibrillate, but it didn’t turn out that way. In the pediatric cardiologist’s words; “I knew that night that we finally had a tool that would define the anatomic nature of coronary artery disease.”
In the aftermath of the close call – albeit one that opened the door to a new pathway in medicine, Sones perfected the revolutionary new technique for producing high quality diagnostic images of the coronary arteries using specially-designed catheters. From his work, there were only a few more heartbeats separating diagnosis and modern day therapeutic interventions like bypass surgery and coronary angioplasty.
Charles Dotter, M.D., a vascular radiologist at Oregon Health Sciences University in Portland, finally pushed the envelope of using catheters to treat actual medical problems through to its logical conclusion in 1964. Working with Melvin Judkins, M.D. and using several different-sized catheters, Dotter was able to open blocked arteries and improve blood flow in patients with arteriosclerosis in peripheral (leg) arteries.
Because his work focused on the arteries in the legs instead of the heart, Dotter was dubbed the “father of interventional radiology.” Interventional radiology, in case a reminder is necessary, is the field of medicine in which circulatory experts treat a range of problems exclusive to the heart. The doctors that treat the heart clustered in their own club under the title of interventional cardiology.
Thus, after a mere 5,000 years tentative exploration from Egypt on, not to mention an explosive three centuries of concerted scientific experimentation once western civilization got cranking, the practice of treating medical conditions without making major surgical incisions was poised on the threshold. Not only were interventional cardiologists gathering strength within the wings for revolutionary new ways of treating heart disease with catheters instead of scalpels, interventional radiologists were ready to build on Dotter’s trailblazing work and investigate other areas of the body that might respond to this type of minimally invasive medicine.
Life, though, rarely turns out as tidily as planned. In the final part of this series, we’ll highlight how despite the most sincere efforts, IR’s new kid on the block status just wouldn’t go away. We’ll compare interventional radiology’s experience with that of interventional cardiology, and in the process, we’ll explain what all this history has meant for patients like women suffering from uterine fibroids.
Continued in Part Two