FUTURE-DIRECTIONS IN VASCULAR INTERVENTIONAL RADIOLOGY

Advances in vascular interventional radiology have occurred at a dramatic rate over the last 15 years. Although it is not likely that changes will be as striking and important over the next 15 years, it is likely that substantial changes will occur, ones that are likely to have significant impact on health care. Such changes can be considered in three areas: vascular imaging, vascular treatment modalities, and understanding of the role and effects of such minimally-invasive treatment. In regard to imaging, there have been major advances in the role of non-invasive modalities, namely ultrasound, CT and MRI. It is likely that angiography as a purely diagnostic modality will continue to decrease in importance. Simultaneously, however, percutaneous interventions are increasing in importance, and this mandates continued attention to safer and more effective contrast agents. Regarding treatment, stents have already come to play an important role, and this is likely to expand with the availability of various types of stents and stent grafts. Other devices, ranging from different types of angioplasty balloons to atherectomy-and thrombectomy catheters, are also undergoing investigation. With all devices, and with all interventions for vascular disease, a critical issue is an improved understanding of the response to therapy. Restenosis following angioplasty has been a major problem, both theoretically and in terms of optimal technology use. Many investigators have attempted to both understand and alter restenosis. Recently, there has been some success, both pharmacologically and with the use of devices such as stents. Vascular interventional radiology continues to face many challenges and many opportunities. This field is likely to continue to grow, and to play an increasing role inpatient care.