The origins of interventional radiology are in the Seldinger technique described in the early 1950s by Seldinger.<sup>78 Stanley P. Angiographic procedure Pediatric Angiography Baltimore: Williams and Wilkins (1982). 

Cliccare qui per andare alla sezione Riferimenti</sup> This system allowed access to an artery with a needle followed by a wire and catheter placement. The performance of percutaneous interventional procedures has progressed substantially with the development of cross-sectional imaging including ultrasound, computed tomography (CT), and magnetic resonance (MR) imaging, as well as the development of high-resolution image-intensified fluoroscopy. At the same time there also has been significant development in materials and technology, with numerous needles, wires, balloons, stents, and embolic materials becoming available. There also has been a significant improvement in the care of the pediatric patient, with better anesthesia and sedation and improved monitoring.<sup>11 Chait P.G. Interventional gastrointestinal radiology Pediatric Gastrointestinal Disease St. Louis: Mosby (1996).  1775-1799

Cliccare qui per andare alla sezione Riferimenti, 22 Dondelinger R.F. A short history of nonvascular interventional radiology J Belge Radiol 1995 ;  78 : 363-370

Cliccare qui per andare alla sezione Riferimenti</sup>

The spectrum of available interventional procedures is shown in Figure 1. Access to a system, conduit, or mass is achieved either through imaging using ultrasound, CT, fluoroscopy, or MR imaging, by palpation (e.g., of the femoral artery), or by anatomic landmarks (e.g., femoral vein medial to the femoral artery). Once access has been obtained with a needle, the needle can be used for biopsy or aspiration or a wire can be placed followed by numerous interventional or diagnostic procedures. These include arteriogram, venogram, stent placement, dilatation, filter placement, stent removal, and embolization.

The growth of pediatric interventional radiology has lagged behind the adult interventional programs. The disease processes seen in the pediatric population are significantly different from those of adults and techniques and use of imaging therefore is different.<sup>82 Towbin R., Ball W. Pediatric interventional radiology Radiol Clin North Am 1988 ;  26 : 419-440

Cliccare qui per andare alla sezione Riferimenti, 85 VanSonnenberg E., Wittich G.R., Cabrera O. , e al. Percutaneous diagnostic and therapeutic interventional radiologic procedures in children: Experience in 100 patients Radiology 1987 ;  162 : 601-605

Cliccare qui per andare alla sezione Riferimenti</sup> As children are generally not cooperative, sedation or general anesthesia often is required.

Additionally, if the pediatric interventional radiologist is going to be performing procedures on patients under sedation with the assistance of a nurse clinician, a good knowledge of the drugs and combination of drugs for sedation and analgesia, as well as the treatment of complications from the use of these drugs, is required.<sup>11 Chait P.G. Interventional gastrointestinal radiology Pediatric Gastrointestinal Disease St. Louis: Mosby (1996).  1775-1799

Cliccare qui per andare alla sezione Riferimenti</sup> The decision to do a procedure under general anesthesia is the choice of the interventional radiologist, and this also requires some knowledge not only of the disease process but of the patient, requiring consultation with the referring service and physician. General anesthesia is used for procedures that require complete patient cooperation, painful or lengthy procedures, procedures that are risky in terms of closeness to vital organs, or patients who have failed sedation previously.