Table of Contents  
HISTORICAL VIGNETTE
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 42-43

Charles Dotter M.D.


Department of Vascular and Endovascular Surg, Sir Ganga Ram Hospital, New Delhi, India

Date of Web Publication31-Jan-2018

Correspondence Address:
Dr. Ambarish Satwik
Department of Vascular and Endovascular Surg, Sir Ganga Ram Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_82_17

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How to cite this article:
Satwik A. Charles Dotter M.D. Indian J Vasc Endovasc Surg 2018;5:42-3

How to cite this URL:
Satwik A. Charles Dotter M.D. Indian J Vasc Endovasc Surg [serial online] 2018 [cited 2020 May 29];5:42-3. Available from: http://www.indjvascsurg.org/text.asp?2018/5/1/42/224459



Perhaps what earned him the tag of Crazy Charlie was the centerspread Life Magazine did on him in August 1964. Sandwiched between a three-paged fashion advertorial for Dacron and a photo-essay on the splendors of the Vanderbilts of America, was the feature “Clearing an Artery.” It showed him like a crazed maniac at the point of thrusting a guidewire through an occluded femoral artery, his face contorting with the deranged, high-metabolic look of a mad scientist or a sexual assaulter. “Plumbing style snake restores blocked circulation” read the byline.[1] It was the story of the first catheter therapy narrated with a great dramatic flourish in America's favorite weekly magazine. A series of photographs captured the cinematic white heat of the moment: images of Charles Dotter performing a ream-job on the artery with a manic grin, looking at a first-generation television fluoroscope, using a technique straight out a plumber's manual.

Charles Dotter's angioplasty was a transluminal dilatation of the blocked segment with a tapered rigid sheath, a long stainless-steel spring encased in a plastic sleeve that brutally reamed out the blocked segment. Dotter would make his catheters himself using Teflon and a blowtorch. This particular sheath of telescoped catheters was designed by him, but produced by his friend Bill Cook, the sole employee and proprietor of Cook Incorporated. He called it the Dotter Dilatation Set.[2] The Dotter revolution happened almost around the same time Bill Cook was getting his company started.[3]

The angiograms of the first beneficiary the Dotter Dilatation Set have been saved for posterity. Her name was Laura Shaw, 82 years old, who had presented with rest pain and gangrene of the toes.[4] She had been referred to Dotter as a basket case just before amputation. It was a Superficial Femoral artery lesion which responded splendidly to the dilatation. Follow-up angiograms 6 months later showed the treated vessel to be patent. She was fully ambulant for 3 years after the intervention and died eventually of congestive heart failure.[5],[6]

Charles Dotter's oeuvre was that of a prime mover-cum-inventor. At the age of 32 he was named professor and chairman of the Department of Radiology at the University of Oregon Medical School, 2 years after he joined the department as a rookie. It was to be his playground-laboratory for the next 32.[4] It was there that he sired a new specialty, Interventional Radiology. In 1963, at the Czechoslovak Radiological Congress at Karlovy Vary, this is how Dotter ended his hour-long paper on the future of Radiology: “The angiographic catheter can be more than a tool for the passive means of diagnostic observation. Used with a little imagination, it can become an important surgical instrument.”[7]



And so, a minor turf war began at the med school in Portland, Oregon. Dotter's services were sought only for diagnostic purposes. Requisition forms were sent to him with the stipulation “visualize but do not try to fix.”[2] Dotter, in front of his trainees, would often crow over his artifice in fixing one such “do not fix” patient with a proximal Superficial Femoral artery occlusion who was planned for an endarterectomy. He did not touch the superficial femoral artery (SFA) but dilated a severely stenotic Profunda.[5] “They did not say anything about the Profunda,” he would tell his trainees waggishly. The SFA surgery failed but the dilated Profunda stayed patent for 5 years and saved the patient's limb. In a training video on transluminal angioplasty issued by Dotter in 1972, there is an image of Dotter and his “do not fix” patient summiting Mount Hood (11,000 feet) roughly a year after his Profunda treatment.[5]



Charles Dotter M. D., never to fall to insipid mediocrity, was a seasoned mountaineer and pilot. He had vowed to climb all 67 peaks over 14,000 feet in North America [8] and kept his vow, despite his fight against Hodgkin's Lymphoma and two cardiac surgeries. He marked the remission of his Lymphoma postradiotherapy in 1970 by climbing the Matterhorn, one of the highest summits in the Alps (at 14,000 feet), without a guide.[2] It was the kind of valor required of a pioneer and frontiersman.

To Dotter's spasms of inventive acuity, we owe the great innovations of the endovascular era: the X-ray tube that admitted millisecond exposures, the J-tipped guidewire, the flow-directed balloon catheter, a prototype of the stent, the “loop-snare” retrieving catheter, catheter-directed thrombolysis and so on.[9] His genius and great talent sprang from the plumber's curiosity and his faculty for transforming objects into devices. It would not, actually, be anomalous and overreaching to say that the endovascular era was a product of Dotter's imagination.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Life Magazine. 14 August, 1964. p. 43-6.  Back to cited text no. 1
    
2.
Rosch J, Abrams HL, Cook W. Memorials: Charles Theodore Dotter, 1920-1985. AJR Am J Roentgenol 1985;144:1321-3.  Back to cited text no. 2
    
3.
Hammel B. The Bill Cook Story: Ready, Fire, Aim. Indiana University Press; p. 147-52.  Back to cited text no. 3
    
4.
Friedman SG. Charles dotter: Interventional radiologist. Radiology 1989;172:921-4.  Back to cited text no. 4
[PUBMED]    
5.
Dotter CT. Percutaneous Transluminal Angioplasty [Training Video]; 1972.  Back to cited text no. 5
    
6.
Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction. Description of a new technic and a preliminary report of its application. Circulation 1964;30:654-70.  Back to cited text no. 6
[PUBMED]    
7.
Dotter CT. Cardiac catheterization and angiographic technics of the future. Background and current status of clinical catheter angiography. Cesk Radiol 1965;19:217-36.  Back to cited text no. 7
[PUBMED]    
8.
The American Alpine Journal. American Alpine club; 1985. p. 376-7.  Back to cited text no. 8
    
9.
Keller FS, Rosch J. A personal memoir of Charles Dotter [foreword]. In: The Father of Interventional Radiology. Charles Dotter: Highlights of his Life and Research. Toyko: Excerpta Medica Publishers; 1994. p. 7-9.  Back to cited text no. 9
    




 

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