The future of catheter-based angiography: implications for the vascular interventionalist

Based on the assumptions mentioned previously, the author makes the following predictions regarding catheter-based angiography and related procedures: 1. Most diagnostic angiography will be performed with noninvasive methods. In the peripheral circulation. MRA will be the predominant method, with CTA having an important role in aortic imaging and coronary imaging. MRA will have increased use for elective diagnosis and in clinical emergencies. 2. Catheter-based angiography will have an important role as an adjunct or preliminary procedure related to interventions. This is significant for planning catheter development and functionality of future angiographic equipment. 3. The need for angiographic equipment will continue to grow despite this decrease in diagnostic application, as a result of increase in interventional therapy. This increase in therapy will be a result of a variety of factors, including aging population, early diagnosis, and increasing acceptance of less invasive therapy. 4. Interventionists should be considering and planning for vascular imaging devices--MRA, CTA, and US--to be included as part of the interventional sections and the workload. 5. Cardiovascular imaging should be a clinical imaging specialty, with patient interaction at the time of imaging. 6. These changes should be embraced by vascular interventionalists, who should incorporate these tools into their clinical practice. 7. The changes, if they occur as predicted, will create significant problems in training skilled interventionists who will not have the foundation of diagnostic angiography on which to build complex endovascular skills.