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Interventional radiology (IR), also known as vascular and interventional radiology (VIR) or surgical radiology, is an independent medical specialty (previously a sub-specialty of radiology) providing minimally invasive image-guided diagnosis and treatment of diseases in every organ system. Although the range of procedures performed by interventional radiologists is broad, the unifying concept behind these therapies is the use of the most modern, least invasive technique available in order to minimize risk to the patient and improve health outcomes. As the inventors of angioplasty and the catheter-delivered stent, interventional radiologists pioneered modern minimally invasive medicine. Using X-rays, CT, ultrasound, MRI, and other imaging modalities, interventional radiologists obtain images which are then used to direct interventional instruments throughout the body. These procedures are usually performed using needles and narrow tubes called catheters, rather than by making large incisions into the body as in traditional surgery. Many conditions that once required open surgery can now be treated non-surgically by interventional radiologists. By minimizing the physical trauma to the patient, non-surgical interventions can reduce infection rates and recovery time, as well as shorten hospital stays.〔Society of Interventional Radiology -- Global Statement Defining Interventional radiology. http://www.sirweb.org/news/newsPDF/IR_Global_Statement.pdf〕 ==History== 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. Early history began in the 1920s with the development of the angiography technique, which constitutes the basis for any vascular intervention. The angiography technique was first developed in 1927 by the Portuguese physician and neurologist Egas Moniz at the University of Lisbon to provide contrasted x-ray cerebral angiography into vessels in order to diagnose several kinds of nervous diseases, such as tumors, artery disease and arteriovenous malformations. He is usually recognized as one of the pioneers in this field. Moniz performed the first cerebral angiogram in Lisbon in 1927, and Reynaldo Cid dos Santos performed the first aortogram in the same city in 1929. With the introduction of the Seldinger technique in 1953, the procedure became markedly safer as no sharp introductory devices needed to remain inside the vessel. Interventional radiologists later 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. The growth of interventional radiology was fueled by ties between interventionalists such as Charles Dotter and innovative device manufacturers like Bill Cook. Interventional radiologist Charles Dotter, MD, known as the "Father of Interventional Radiology" for pioneering this technique, was nominated for the Nobel Prize in Physiology or Medicine in 1978. Alexander Margulis coined the term "interventional" for these new, minimally invasive techniques. He emphasized that to continue to be on the forefront of innovation, interventional radiologists must possess special training, technical skill, clinical knowledge, ability to care for patients, and closely collaborate with surgeons and internal medicine subspecialists. Development of stents began slowly. In 1969, Dotter conceived the idea of expandable stents with an intra-arterial coil spring. The first stents developed by Dotter and Andrew Craig were made of nitinol. Gianturco introduced his self-expandable Z stent. Hans Wallsten introduced a self-expandable mesh stent, Ernst Strecker a knitted tantalum stent and Julio Palmaz his balloon expandable stent, which was later perfected and introduced to clinical practice. Coronary artery angioplasty and stenting arguably revolutionized the practice of cardiology. Treatment of GI bleeding has a storied tradition. After introduction of selective vasoconstrictive infusions by Baum, Josef Rösch introduced selective arterial embolization for treatment of uncontrollable bleeding in the early 70s. Anders Lundequist treated variceal bleeding with the technique of transhepatic variceal embolization in the mid 70s. Interventions in the biliary tract were developed by several pioneers. Interventional Radiologist Joachim Burrhenne invented and perfected the technique of percutaneous removal of retained billiary stones. Plinio Rossi and Hall Coons enriched biliary interventions with their work using biliary stents. The innovative interventionalists Kurt Amplatz, Willi Castaneda and Dave Hunter pioneered percutaneous uroradiologic interventions. They popularized nephrostomy drainage, percutaneous stone extraction, and ureteral stenting. The field of interventional oncology was pioneered by IR legends. Bob White pioneered embolization techniques for pulmonary AVMs. Sid Wallace was one of the first to treat bone and kidney tumors by embolization and treatment of disseminated liver metastases. Today many conditions that once required surgery can be treated nonsurgically by interventional radiologists. Through a small nick 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. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Interventional radiology」の詳細全文を読む スポンサード リンク
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