Interventional Radiology represents the merging of two different ideas concerning diagnosis and treatment. This specialty utilizes an array of diagnostic technology (such as x-rays, ultrasound, CT, and MRI) and combines the information gained from that technology to offer treatment solutions for a number of different medical conditions. As a result, the evolution of IR as a medical specialty includes the evolution of imaging technology as well as the techniques and equipment integral to our therapeutic solutions. Over time, as these paths converged to become more refined, the field of IR has matured and has experienced consistent growth that has allowed it to be at the forefront of medicine.
It is difficult to agree on the actual starting point for IR. One can look to ancient Greece as early as 400 BC to find the first use of catheters to perform enemas. One can also look to the Egyptians who developed the first syringe in the 9'th century to remove cataracts as well as to the work of Christopher Wren and Johann Daniel Major in the 1600s who described the technique of IV injections. Finally, one can look to the work of Wilhelm Roentgen and the development of x-rays in the late 1800s. Once these building blocks were in place, it was up to a few smart people to figure out how to put them together and help develop a new field of medicine.
Most people credit Werner Forssman with performing the first vascular catheterization. His goal was to inject drugs directly into the heart, and he proved that this was possible by advancing a catheter through a vein into his own arm and then passed the catheter directly into his heart. He passed the catheter into his vein through a large needle, which explains why the technique developed by Sven Seldinger was so important. Seldinger realized that large catheters were needed to perform the contrast injections that were a necessary part of angiography. However, he wanted to develop an easier way to advance a large catheter into a vein or artery that didn't require a large surgical incision or the use of a large needle. At the age of 32, he developed the now famous "Seldinger Technique." This technique involves placing a needle into the blood vessel, advancing a guidewire through that needle, removing the needle, and then advancing a catheter over the guidewire. Once the catheter is in place, the guidewire could be removed. It is clear now that this technique is what pushed the idea of minimally invasive into medicine. By developing a technique that enabled placement of a catheter into a blood vessel through a hole no larger than the size of the catheter, Seldinger opened the door to many innovations. Even today, this technique is used not only in vascular interventions but as a routine part of nonvascular interventions such as biliary and abscess drainages as well as nephrostomy tube and gastrostomy tube placements.
Charles Dotter is almost universally considered the most significant and influential figure behind the development of IR. He was the first to introduce the technique of percutaneous catheterization into the United States and subsequently extended the capabilities of physicians skilled in these nonsurgical procedures. He is perhaps best known for performing the initial angioplasty in a patient with peripheral arterial disease. This took place in 1964. This took several decades to be fully accepted as a treatment for peripheral arterial disease but in time, it has grown into the preferred way to treat this condition.
In the 1960s and 1970s, several other procedures inherent to the practice of IR were conceptualized and investigated. The Mobin-Uddin Umbrella Filter was developed as a treatment for DVT. This led to Lazar Greenfield (working with Garman Kimmell who ran an oil pipeline company) to develop the Greenfield filter, which was used for several decades to prevent PE in patients with DVT. Embolization procedures were also first performed during this time. Lussenhop and Spence were the first to report the use of catheter embolization to occlude a cerebral AVM. Josef Rosch was then the first to publish a case of arterial embolization to treat GI bleeding using autologous clot and an epinephrine infusion. Shortly thereafter, Cesare Gianturco developed embolization coils and Kurt Amplatz reported the first use of Ivalon as a particulate embolic agent. Before his death in 1985, Charles Dotter conceptualized the idea of a vascular stent. However, it was Julio Palmaz and Hans Wallsten who were the first to develop balloon-expandable and self-expanding stents in the 1980s for use in the peripheral vasculature.
These pioneering advances laid the groundwork for many of the procedures we perform today. The concept initiated by the Greenfield filter has evolved into the retrievable filters that we use today. The early stents of Palmaz and Wallsten have evolved into the drug-eluting stents, stent-grafts, and resorbable stents that are either in use today or being developed for tomorrow. It also enabled procedures such as a TIPS procedure to be developed by Palmaz, Rosch, Ronald Colapinto, and Goetz Richter, as a life-saving technique for patients with cirrhosis and the sequelae of portal hypertension. Similarly, the early work in embolization has led to revolutionary changes that we are seeing every day in practice. Doyon, Yamada, Wallace, and Soulen developed the ideas and techniques behind chemoembolization to treat liver cancer and Jacques Ravina developed the uterine fibroid embolization procedure that is commonly used today to treat women with symptomatic uterine fibroids. The developments in embolization continue to move rapidly forward with the introduction of yttrium-90 microspheres, liquid embolic agents, and resorbable embolic agents and the investigation into new uses for embolization as a treatment for conditions such as morbid obesity and benign prostatic hyperplasia.