Sven-Ivar Seldinger

Sven-Ivar Seldinger (1921-1998), a Swedish radiologist, is primarily remembered for the invention of his revolutionary eponymous technique. 

Early life

Sven-Ivar Seldinger was born in Mora, Dalarna, Sweden on 19 April 1921 ⁵. He attended medical school at the Karolinska Institute in Stockholm graduating in 1948. His training in diagnostic radiology began in 1950 at the Karolinska Sjukhuset.  

Development of the Seldinger technique

During these years in Stockholm he was very productive, beginning with his initial and most important paper on percutaneous catheterization in 1953 ¹. The technique was actually originally presented at the Congress of the Northern Association of Medical Radiology in Helsinki, Finland in June 1952 ⁵. Impressively his novel technique was developed and published when he was still a radiology trainee!

Before he invented his novel catheterization technique he found that the contemporary techniques were challenging and limiting. Large bore needles were the custom to allow large bore catheters to be inserted resulting in high risks of significant bleeding. Also advancing the catheters into the arteries was very difficult due to the intrinsic flexibility of the polyurethane catheter. This hurdle was overcome by the use of a stiff wire with a flexible tip, or as he called it in his paper, a metal leader.

At first attempt he was unsuccessful and then he had a eureka moment, in his own words:

"Now! After an unsuccessful attempt to use this technique I found myself disappointed and sad, with three objects in my hand - a needle, a wire and a catheter - and… in a split second I realized in what sequence I should use them: Needle in - wire in - needle off - catheter on wire - catheter in - catheter advance - wire off.

I have been asked how this idea turned up and I quote Phokion, the Greek. “I had a severe attack of common sense"."

Realizing the potential of his innovation, Dr Seldinger applied it to the first localization of a parathyroid adenoma by arteriography and the first selective renal angiography. He used it to puncture the bile ducts for cholangiography and to puncture the liver and spleen for portal venography. He was among the first to undertake percutaneous transhepatic cholangiography in 1962. Seldinger was also interested in portal vein hemodynamics and the reduction of portal hypertension by administration of vasopressin.

Later life

Despite the invention of his groundbreaking procedure his supervisor at the Department of Radiology did not think it sufficed for his thesis. Therefore Dr Seldinger pursued and defended his thesis on percutaneous transhepatic cholangiography in Stockholm in 1966. He was made a Docent in Radiology in 1967.

After completion of his training at Karolinska Sjukhuset, Dr Seldinger stayed on as a member of faculty until 1966.

In 1967 Dr Seldinger took up a new position as the Radiologist-in-Chief, at Mora Lasarett, the community hospital, in his hometown. He held this position until his retirement in 1986 ². He died at home on 21 February 1998 ⁵; he predeceased his wife, Britt-Liss, a renowned painter, and three daughters, Mari, Nina, and Mona ².

Accolades

• Valentine award from the New York Academy of Medicine 1975
• first recipient of the “Pioneer in Interventional Radiology Award” by the American Society of Cardiovascular and Interventional Radiology in 1992
• honorary memberships:
  • Society of Interventional Radiology (US)
  • Swedish Association of Medical Radiology
  • German Roentgen Association

Legacy

Herbert Abrams (1920-2016), himself a pioneering interventional radiologist, wrote this in a tribute to Seldinger published in AJR in 1984.

“In the movement of angiography from the part of a bit player to that of a protagonist in the scenario of 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 creativity 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” ⁴.