Introduction to Contemporary Pediatric Interventional Radiology

Having “pediatric IR” be the featured topic in this issue of “Seminars in Interventional Radiology” is a big deal. It is a big deal for our pediatric community and a big deal for our pediatric patients.

To say that minimally invasive, image-guided therapy has rapidly evolved in children over the last decade would be a gross understatement. The field is moving so quickly that it can sometimes be difficult to keep up—even for those of us who practice in this space every day. Over the past 10 to 15 years, we have seen a proliferation of low-profile vascular devices in adults designed to perform increasingly elegant procedures in the brain for neurologic interventions, as well as below the knee for PAD specialists. These devices have subsequently allowed pediatric IRs to perform procedures in our smallest patients that were simply not previously feasible due to size constraints and small anatomy. Over the same time period, we have seen IR physicians become content experts and world leaders in the fields of vascular anomalies and renovascular hypertension. Outpatient IR clinics, which were historically only an option for adults, are becoming increasingly common at children's hospitals throughout the globe. Over the same time period, pediatric IR has increasingly been recognized as a distinct subspecialty of IR, with the establishment of an increasing number of pediatric IR fellowship programs. It is, indeed, an exciting time to be a pediatric interventional radiologist.

There are several ways (addressed by articles in this issue) in which IR has recently influenced pediatric and adolescent medicine. For example, there are certain procedures, such as central venous access and benign bone tumor management, in which minimally invasive, image-guided procedures have become first-line options, often replacing more conventional surgical options. In other instances, as we have developed a more keen understanding of the pathophysiology of pediatric renovascular and portal hypertension, IR has become the primary specialty for both diagnosis and procedural management. Additionally, as the pediatric IR community has become more adept at applying lessons learned from our adult IR colleagues, we are now simply able to offer therapy for kids in disease processes for which no therapeutic option previously existed. This is particularly true in venous pathologies, interventional oncology, and pain/palliation—all addressed in this issue.

Importantly, two of the articles in this issue are intended to emphasize, for all IRs, that therapies used to treat adults are often not applicable to pediatric diseases. Specifically, in this issue, our colleagues from the pediatric thrombosis and oncology communities share with readers how anticoagulation (in the setting of pediatric thrombosis) and oncologic therapy (in the setting of pediatric cancer) are substantially different than the adult space, as well as describe how strict, disciplined trial-design in pediatrics sometimes limits the instances in which minimally-invasive percutaneous or catheter-based therapies can be pursued in children.

Lastly, as innovation is at the heart of our specialty, two articles specifically address clinical scenarios in which IR lives on the cutting edge: contemporary management of vascular anomalies (beyond just sclerotherapy) and MR lymphangiography indications and findings in pediatric lymphatic disorders.

I am confident that the quality of the content throughout this issue will impress even the most cynical skeptic. And I want to personally thank the authors, who are truly leaders in this field, for taking the time to share their knowledge and experience with the readership.

Perhaps most importantly, I challenge you—the reader—to digest this content through the lens of those of us who have committed our careers to taking care of kids by remembering two core tenets of pediatric medicine: (1) always remember that in this business, we treat families—not individual patients, and (2) our goal is not necessarily to prolong life—but rather, set our kids up to become their healthiest adult selves.

Enjoy.

Publication History

Article published online:
10 October 2025