Advances in Imaging Technology and the Growth of Vascular and Interventional Radiology: A Brief History

THE development of vascular and interventional radiology (IR) as a discipline or a set of patient-care techniques can be described from many viewpoints. One could study its pioneering and innovative physicians or assess how advances in catheters and other device-based technologies have influenced the course of vascular and IR. This article will focus on how imaging technology has shaped the discipline. The advent and subsequent evolution of the modern fluoroscopically based angiographic interventional suite enabled the development of early diagnostic angiography and subsequent interventions. Cross-sectional imaging techniques such as computerized axial tomography and real-time ultrasound (US) also enabled the development of specific interventions. These modalities have also had a profound influence on case selection and case mix and have helped catalyze the evolution of vascular and IR into an interventional specialty. The first iodine-based contrast arteriogram in a patient was reported in 1929 by Dos Santos (1), approximately 34 years after the discovery of the x ray (2) and almost simultaneously with the description of the first iodinated contrast medium (3). Without the benefit of fluoroscopy, a nonselective aortogram could be obtained only by a blind translumbar puncture advancing a stiff metallic cannula with use of surface anatomic landmarks. Filming consisted of a timed single radiographic exposure. Evolution of the translumbar technique was relatively glacial for three decades, probably for two reasons. First, there was no real push to develop it because there were few operative techniques for atherosclerotic occlusive disease or aneurysmal disease, and therefore there were few real indications for the procedure. Second, there was no practical imaging technique that allowed easy and effective visualization of catheter manipulation in real time.