The History of Interventional Radiology
Interventional Radiologists are Minimally Invasive Specialists
The landscape of medicine is constantly changing, and for the
past 30 years, interventional radiologists have been responsible
for much of the medical innovation and development of the
minimally invasive procedures that are commonplace today.
Interventional radiologists pioneered modern medicine with the
invention of angioplasty and the catheter-delivered stent, which
were first used to treat peripheral arterial disease. By using a
catheter to open the blocked artery, the procedure allowed an
82-year-old woman, who refused amputation surgery, to keep her
gangrene-ravaged left foot. To her surgeon’s disbelief, her
pain ceased, she started walking, and three
"irreversibly" gangrenous toes spontaneously sloughed.
She left the hospital on her feet—both of them. Charles
Dotter, MD, the interventional radiologist that pioneered this
technique, is known as the "Father of Interventional
Radiology," and was nominated for the Nobel Prize in
medicine in 1978.
Angioplasty and stenting revolutionized medicine and led the
way for the more widely known applications of coronary artery
angioplasty and stenting that revolutionized the practice of
cardiology. Today many conditions that once required surgery can
be treated nonsurgically by interventional radiologists. Through
a small knick in the skin, they use tiny catheters and miniature
instruments so small they can be run through a person’s
network of arteries to treat at the site of illness internally,
saving the patient from open invasive surgery. While no treatment
is risk free, the risks of interventional procedures are far
lower than the risks of open surgery, and are a major advance in
medicine for patients.
Some of the more recent advances in interventional radiology
include:
- Nonsurgical ablation of tumors to kill cancer without
harming the surrounding tissue
- Embolization therapy to stop hemorrhaging or to block the
blood supply to a tumor
- Catheter-directed thrombolysis to clear blood clots,
preventing disability from deep vein thrombosis and
stroke
- Carotid artery angioplasty and stenting to prevent stroke
Milestones Pioneered by Interventional Radiologists
1964 Angioplasty
1966 Embolization therapy to treat tumors and spinal cord
vascular malformations by blocking the blood flow
1967 The Judkins technique of coronary angiography, the
technique still most widely used around the world today
1967 Closure of the patent ductus arteriosis, a heart defect
in newborns of a vascular opening between the pulmonary artery
and the aorta
1967 Selective vasoconstriction infusions for hemorrhage, now
commonly used for bleeding ulcers, GI bleeding and arterial
bleeding
1969 The catheter-delivered stenting technique and prototype
stent
1960-74 Tools for interventions such as heparinized
guidewires, contrast injector, disposable catheter needles and
see-through film changer
1970’s Percutaneous removal of common bile duct stones
1970’s Occlusive coils
1972 Selective arterial embolization for GI bleeding, which
was adapted to treat massive bleeding in other arteries in the
body and to block blood supply to tumors
1973 Embolization for pelvic trauma
1974 Selective arterial thrombolysis for arterial occlusions,
now used to treat blood clots, stroke, DVT, etc.
1974 Transhepatic embolization for variceal bleeding
1977-78 Embolization technique for pulmonary arteriovenous
malformations and varicoceles
1977-83 Bland- and chemo-embolization for treatment of
hepatocellular cancer and disseminated liver metastases
1980 Cryoablation to freeze liver tumors
1980 Development of special tools and devices for biliary
manipulation
1980’s Biliary stents to allow bile to flow from the
liver saving patients from biliary bypass surgery
1981 Embolization technique for spleen trauma
1982 TIPS (transjugular intrahepatic portosystemic shunt) to
improve blood flow in damaged livers from conditions such as
cirrhosis and hepatitis C
1982 Dilators for interventional urology, percutaneous removal
of kidney stones
1983 The balloon-expandable stent (peripheral) used today
1985 Self-expandable stents
1990 Percutaneous extraction of gallbladder stones
1990 Radiofrequency ablation (RFA) technique for liver tumors
1990’s Treatment of bone and kidney tumors by
embolization
1990’s RFA for soft tissue tumors, i.e., bone, breast,
kidney, lung and liver cancer
1991 Abdominal aortic stent grafts
1994 The balloon-expandable coronary stent used today
1997 Intra-arterial delivery of tumor-killing viruses and gene
therapy vectors to the liver
1999 Percutaneous delivery of pancreatic islet cells to the
liver for transplantation to treat diabetes
1999 Developed the endovenous laser ablation procedure to
treat varicose veins and venous disease
Resources
The Birth, Early Years, and
Future of Interventional Radiology.
Josef Rösch, Frederick S. Keller, and John A. Kaufman.
J. Vasc. Interv. Radiol. 2003 14: 841-853.
The Catheter Introducers by Leslie A. Geddes and LaNelle
E. Geddes, copyright 1993 by Cook Group Incorporated, Mobium Press,
Chicago.
The Ship in the Balloon: The Story of Boston Scientific and
the Development of Less-Invasive Medicine by Jeffrey L. Rodengen,
copyright 2001 by Write Stuff Enterprises, Inc.
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