How did we start seeing our vessels: A history of angiography

Index Home

While we knew for a long time, that blood travels inside conduits or vessels, we did not have much of clarity, till the middle of 16th century. It was only in 1540s, when Andreas Vesalius, a surgeon, anatomist and a medical illustrator drew it all. He first dissected actual human cadavers, and produced illustrations of our muscles, bones, nerves and blood vessels. He wrote a seven volume book “De Humani Corporis Fabrica Libri Septem“. Third volume of this book is on blood vessels – arteries and veins. He listed all the vessels human eye could see.

From Vesalius to Harvey

Vesalius died in 1564, celebrated through his life as an eminent surgeon, as well as an imperial physician. Fourteen years later, William Harvey was born in England. Harvey was an accomplished medical student in 1602, when he completed his initial medical education. In 1638, he wrote his 72-page work “Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus“. He for the first time correctly described flow of blood, from heart to the organs, and back to the heart. His work challenged prevalent views about circulation of blood, and hence was met with scepticism, and denial. While we call Vesalius as “Father of Modern Anatomy”, Harvey truly described our circulatory system.

Visualising our vessels

William Harvey died in 1657 and for more than 200 subsequent years we could see vessels only in the opened up human bodies. This was possible either during a surgical procedure, or after death. Next advance came after 1895, when Wilhelm Roengten discovered X-rays. Initial radiographs could show bones. Only a month later, two Austrians, E. von Haschek and O. T. Lindenthal attempted an X-ray of an amputated arm. They pushed a chalk like substance into the artery, and could see it as a faint line. This probably was a first angiography, but in a dead limb.

In early 1920’s Earl D Osborne could show that some dyes, when injected in human body are excreted through urine. In this process, urinary tract and bladder could be seen through an X-ray. This was the first pyelography. It is interesting to note, that Osborne was a dermatologist, who died of a vascular occlusion in 1960. However, this demonstration was a foundation in our understanding of blood vessels.

First angiography in a live person

António Egas Moniz was a Portuguese neurologist. Between 1926-29, he tried injecting a variety of substances in carotid artery, to see if these could be seen through an X-ray. He tried strontium and Lithium Bromide in his initial studies. These patients died, without any vessels visualised. After some animal experiments, In 1927, he used Sodium Iodide. He could see vessels of the brain, through an X-ray. This was a landmark discovery, and led to two Nobel Prize nominations. However, Moniz got 1949 Nobel Prize, but this was not for angiography. This Nobel was for a now abandoned procedure of prefrontal leukotomy in patients with schizophrenia.

Two years later, in 1929, Reynaldo dos Santos performed the first aortogram in Lisbon, Portugal. Reynaldo was a surgeon, urologist and an academician. Moniz and Reynaldo performed these early angiographies through directly puncturing the concerned arteries. This was all but a tedious process. We could reach only those vessels that were closer to skin surface. Further, X-ray techniques were also not well developed in these early days.

Angiography paves way for more developments

João Cid dos Santos was a Portuguese vascular surgeon, and a collegue to Moniz and Reynaldo. He was a vascular surgeon, and used angiography to plan vascular surgeries. He pioneered some of the surgeries we do today, to remove clots from vessels (such as endartectomies). These developments in early 1950’s helped more developments.

In 1950’s we developed techniques, through which we could reach deeper vessels. In 1953, Sven Seldinger introduced the Seldinger technique to obtain safe access inside blood vessels, using wires. Seldinger was a radiologist from Sweden. We use the same technique to enter all blood vessels today. By 1960s we were doing our first coronary angiographies. Twenty years later in 1980s, X-rays had become digital, and we developed Digital subtraction angiography – a technique to see our vessels, without interference of other tissues.

Angiography is now a widely available technique, and we can see even tiny vessels in heart, brain, and virtually all organs of our body.