Thomas Fogarty entered medicine through the back door, or at least the supply room door. As an eighth-grader, he got a job dispensing supplies at Good Samaritan Hospital in Cincinnati, Ohio, and worked his way up to being a scrub technician, the person who hands a surgeon tools during an operation. As Fogarty observed the perils of surgery, especially surgery to remove blood clots, his inventive mind explored ways to improve operations. While still a scrub tech, he conceived and built the balloon catheter, a tool to remove clots without major surgery. Since its first use in 1961, the balloon catheter has saved or improved the lives of millions of patients. The balloon catheter also marked the beginning of non-invasive surgery. By minimizing trauma to the patient and reducing time spent under anesthesia, surgical procedures like removing blood clots became much safer and more cost-effective. Non-invasive procedures are now the standard of care for many health problems that once required lengthy surgery.
Fogarty discovered his inventiveness at an early age. Born in Cincinnati in 1934, his father, a railroad engineer, died when he was just eight years old. Fogarty took an active role in the family, taking care of things his father might have. "If my mother needed things fixed," he remembers, "she would call on me." It wasn't much of a stretch for Fogarty; "I just had a natural inclination and inquisitive nature about building things," he says. "I looked at things and just naturally thought, 'Okay, how can I make this better?'" His first mechanical explorations were with soapbox derby cars and model airplanes.
With money tight in his family, Fogarty went to work when he was 14 years old. Between devoting time to work and mechanical tinkering and a general lack of interest, he did not do well in high school. However, by the time he was a senior, Fogarty knew he wanted to be a doctor. With the recommendation of a family priest, he was admitted to Xavier College in Cincinnati.
The Hazards of Blood Clot Surgery
Fogarty needed three jobs and the financial help of a mentor, Dr. Jack Cranley, to get through college. It was while working as a scrub tech during college that Fogarty began to think about better ways to do various surgical procedures. "I had a chance to see what worked and what didn't work," he says. "One of the things that didn't work was the way they took care of blockages in arteries and veins. They would make incisions that were horrendously long and open up the whole artery to try to take the clot out. . . . And it often didn't work, patients died or they had amputations."
In his mind, Fogarty considered different ways to make the procedure betterespecially how to avoid the long incisions. His first idea was to use a modified catheter. Inserted through a small incision, a catheter could get to the clot without much trauma to the patient. And Fogarty had an idea of how to get the clot out once the catheter was there.
The First Balloon Catheter
Fogarty's scheme was straightforward. He started with a urethral catheter, which is flexible but strong enough to be pushed through a blood clot. Then he added a small balloon made from a finger of a latex glove, which could be inflated with saline once it was past the clot. The balloon expands to the size of the artery and is then pulled back out, bringing with it the clot. "You can feel the resistance, or the drag on the artery wall," Fogarty explains. "You adjust the volume of the balloon so you've got continual traction."
There was one main challenge in building such a device. "There was no way to attach the balloon," Fogarty says. The catheter was made of vinyl and the balloon of latex, and no glue available would hold the two together. Fortunately, one of Fogarty's hobbies was fly fishing, and he applied the sport's skill of precise hand-tying to the task. "I'd always tied flies and made lures," he remembers, "so it was just a natural thing."
In 1961, his balloon embolectomy catheternamed for the clot-removal procedure performedwas used for the first time on a human patient. As Fogarty watched, a small incision was made and the catheter was threaded up the patient's blocked artery. When inflated and pulled back out, it did indeed bring the clot with it. Today, the procedure takes about an hour and is done under local anesthesia.
Strengthening Blood Vessels
After Fogarty completed his residency and became a cardiovascular surgeon, he continued to invent new medical devices. He holds more than 60 patents, and some 20 companies have been started to build his devices. One of the most successful of these products is the Fogarty Stent-Graft, an ingenious fix for the difficult problem of abdominal aortic aneurysmsa weakened blood vessel. Rather than removing the bad part of a weakened blood vessel, Fogarty's idea was to strengthen it with an implant: a stent, a thin polyester tube that grabs on to the blood vessel with metal "rings." An inflatable catheter transports the stent to the weakened vessel. When the balloon is inflated the stent expands to the size of the artery and blood flows normally.
The stent and other instrumentsdesigned by Fogarty and many othershave had a far-reaching impact on medical care. Many surgical procedures are now done in non-invasive ways, protecting patients' health as well as being more cost-effective. When Fogarty built his first balloon catheter, he says, "I had no concept that [non-invasive surgery] would reach the magnitude that it has." Yet the movement toward non-invasive techniques is a logical extension of the concerns he wrestled with back in 1960, as he watched both surgeons and patients struggle with the dangers of blood clot surgery. "If you look at the issues I was trying to solve at that time," he explains, "they are the same issues applied to all these other things we do non-invasively. We minimize the anesthesia, we minimize the tissue trauma, and we shorten the recovery. Those were the things I felt I had to do. And those are the things we now do with everything that's less invasive."