The Birth, Early Years, and Future of Interventional Radiology

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THE BIRTH OF INTERVENTIONAL RADIOLOGY

Interventional radiology developed from diagnostic angiography and from the innovative minds and technical skills of many angiographers. Charles Dotter (Fig 1) (1) conceived interventional radiology in the early 1960s and first officially spoke about it on June 19, 1963, at the Czechoslovak Radiological Congress in Karlovy Vary. In his more than 1 hour presentation, “Cardiac catheterization and angiographic techniques of the future,” he discussed, among other topics, catheter biopsy, controlled

THE EARLY YEARS OF INTERVENTIONAL RADIOLOGY

The most exciting years of our professional lives were from the late 1960s to the mid 1980s. Dotter's papers, his lectures, and, later, daily work with him were constant inspirations to us that changed our orientation from diagnostic angiographers to interventionalists. We can still hear his voice telling us that, whenever examining the patient, we must not only concentrate on improving diagnoses, but we must also always think about potential ways to percutaneously treat whatever we find. We

EARLY HIGHLIGHTS IN PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY

After a few successful procedures, Dotter started an aggressive campaign to recruit patients and gain recognition for PTA. His referrals were mainly from general practitioners and occasionally from internists. Surgeons were not interested in nonsurgical treatment of atheromatous disease and were adamantly opposed to PTA. Dotter's articles in local newspapers and his radio and TV interviews were effective in attracting patients interested in this new procedure. These patients were admitted to

LOCAL THROMBOLYSIS

Dotter introduced catheter-directed thrombolysis in 1972 at the annual meeting of the Radiological Society of North America in Chicago. The origins of the procedure were the treatment of complications of angiography and PTA. Thrombotic occlusions occasionally occurred at the catheter entrance or dilation sites because of the large size of diagnostic coronary catheters (8 F) and coaxial dilation catheters (12 F). Dotter wanted to treat these complications with interventional techniques rather

EXPANDABLE STENTS

Dotter started the era of intravascular stent placement in 1969 with the introduction of a transluminally placed coil spring endarterial tube graft Fig 8) (16). Frustrated with the frequently occurring occlusions of a recanalized SFA, he tried to find a percutaneous method to keep the artery open. Of several different types of percutaneously introduced tubings, only the uncoated coil spring tubular prostheses stayed open in canine SFAs. Two of three 1-cm-long coil springs remained patent on

ACUTE GASTROINTESTINAL BLEEDING

Angiographic diagnosis and treatment of acute gastrointestinal bleeding (AGIB) was pioneered by Stanley Baum and Moreye Nusbaum in the 1960s. First, they showed in 1963 that selective visceral cut-film arteriography was capable of demonstrating extravasation at rates as low as 0.5 mL/sec (29). Then, in 1967, after they found in animal experiments that vasoconstrictive infusion of the superior mesenteric artery could reduce portal hypertension (30), they started to use continuous low-dose

TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS

The TIPS technique was developed in canine experiments at the University of California Los Angeles in the late 1960s by Rösch (Fig 15) (38). A modified transeptal Ross needle was used for entrance of the portal vein from a hepatic vein and coaxial Teflon catheters as large as 18 F were used for dilation of the hepatic puncture tract. Rigid Teflon tubing was used in the first animals for the shunt connection. The idea to create TIPS in the early years of interventional radiology was enhanced by

FUTURE OF INTERVENTIONAL RADIOLOGY

The three authors of this article have close to 100 years of collective angiographic and interventional radiology practice and experience. During that time, we have seen almost everything in interventional radiology. Some of us have witnessed and participated in the original introduction of basic procedures that define the specialty, what many would call the “golden days.” Over time, the enthusiastic introduction of new devices and methods resulted in continuously increasing numbers of patients

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