Interventional Radiology | Interventional Radiology

Interventional Radiologists are Minimally Invasive Specialists

What are Interventional Radiologists?
Interventional radiologists are board-certified physicians who specialize in minimally invasive, targeted treatments. They offer the most in-depth knowledge of the least invasive treatments available coupled with diagnostic and clinical experience across all specialties. They use X-rays, MRI and other imaging to advance a catheter in the body, usually in an artery, to treat at the source of the disease non-surgically. As the inventors of angioplasty and the catheter-delivered stent, which were first used in the legs to treat peripheral arterial disease, interventional radiologists pioneered minimally invasive modern medicine.

Today many conditions that once required surgery can be treated nonsurgically by interventional radiologists. Interventional radiology treatments offer less risk, less pain and less recovery time compared to open surgery.

Interventional Radiology Training
Interventional radiology is a recognized medical specialty by the American Board of Medical Specialties. Interventional radiologists are board-certified physicians with additional advanced training in minimally invasive, targeted treatments performed using imaging to guide them. Their board certification includes both Vascular and Interventional Radiology and Diagnostic Radiology which are administered by the American Board of Radiology.

Innovation and Patient Safety

Interventional Radiologists are Experts in Radiation Safety
Interventional radiologists' unique blend of skills fosters innovation and enables them to quickly adapt their imaging expertise to pioneer nonsurgical treatments that are guided by imaging. They adapt a technique proven to work for one problem and apply it to another. When it comes to the best practices for safely performing minimally invasive treatments, interventional radiologists pioneered the procedures and the standards for safety and quality. Patient safety is incorporated into the development of these advances because interventional radiology and diagnostic radiology training programs include radiation safety, radiation physics, the biological effects of radiation, and injury prevention.

Advantages of Interventional Radiology

Most procedures can be performed on an outpatient basis or require only a short hospital stay.
General anesthesia usually is not required.
Risk, pain and recovery time are often significantly reduced.
The procedures are sometimes less expensive than surgery or other alternatives.

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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