Charles Theodore Dotter. The father of intervention

Abstract

The 1st percutaneous transluminal angioplasty marked a new era in the treatment of peripheral atherosclerotic lesions. The early techniques used in peripheral percutaneous transluminal angioplasty form the basis for subsequent percutaneous intervention both in the peripheral and coronary arteries and are largely the contribution of Charles Dotter. Dotter was the 1st to describe flow-directed balloon catheterization, the double-lumen balloon catheter, the safety guidewire, percutaneous arterial stenting, and more. This practical genius dedicated his considerable energy to the belief that there is always a better way to treat disease. His personal contributions to clinical medicine, research, and teaching have saved millions of limbs and lives all over the world.

Fig. 1 Charles Dotter (ca. 1960) (Courtesy of Oregon Health Sciences University)

Fig. 10 Simulated use of the circulator: electric motor, cam, and thrust rod with rubber shoe that contacts the patient's sternum. Patient lies between the motor board and the base of the external circulator. (From: Dotter CT, Straube KR, Strain DC. Circulatory arrest: manual and mechanical means for emergency management. Radiology 1961;77:426-33. Reproduced by permission of the Radiological Society of North America.)

Fig. 2 “My favorite conceptual trademark is a sketch that I did years ago of a crossed pipe and wrench. It's a gross oversimplification, of course, but what it means to me is that if a plumber can do it to pipes, we can do it to blood vessels.” (Courtesy of the Dotter Interventional Institute)

Fig. 3 Dr. Dotter, hand-injecting contrast medium into his patients in the radiology suite. (Courtesy of Oregon Health Sciences University)

Fig. 4 Laura Shaw's left foot 1 week and 5 months after the procedure. (From: 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. Reproduced by permission of the American Heart Association.)

Fig. 5 Angiograms of Dotter's 1st catheter patient, Laura Shaw: A) before transluminal dilation of the left superficial femoral artery, B) immediately after dilation, and C) 3 weeks after the procedure. (From: 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. Reproduced by permission of the American Heart Association.)

Fig. 6 The consultation request that Dotter received in 1964. (Courtesy of Oregon Health Sciences University)

Fig. 7 Angiograms of the “Do not fix” patient, showing atherosclerotic narrowing of the deep femoral artery A) before and B) after transluminal dilation. (From: 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. Reproduced by permission of the American Heart Association.)

Fig. 8 The “Do not fix” patient and Dotter (on right) after reaching the summit of Mt. Hood (ca. 1965). This image is taken from a VHS copy of the original 16-mm film. (From: Dr. Dotter's training video for percutaneous transluminal angioplasty. Courtesy of the Dotter Interventional Institute.)

Fig. 9 Selective coronary arteriogram in the normal dog by the technique of occlusion aortography. LAO = left anterior oblique (From: Dotter CT, Frische LH. Visualization of the coronary circulation by occlusion aortography: a practical method. Radiology 1958;71:503-23. Reproduced by permission of the Radiological Society of North America.)