JVIR HISTORY
Scrubbing with Charles Dotter on an Angioplasty Frederick S. Keller, MD January 15, 1976: It was my first case on my first day of my first rotation on “angiography.” I was in my second year of a 3-year diagnostic radiology residency. Interventional radiology as a subspecialty did not yet exist at that time; invasive intraarterial and intravenous vascular procedures were done in the “angiography” or “special procedures” sections of diagnostic radiology departments. The first case I was assigned to that day was “Mr. Z,” an elderly patient who had traveled from Florida to have Dr. Charles Dotter perform his angioplasty. At that time, patients came to Charles Dotter for angioplasties from all over the United States as well as, for that matter, from all over the world. The scenario was as follows: The patient was admitted to the angiography section of the diagnostic radiology department. The resident on the angiography rotation or the angiography fellow took the history, performed the physical examination, and cared for the patient during his or her hospital stay. Enid Ruble, Charles’ longtime administrative assistant, wrote to patients instructing them to stop taking all their medications 3 days before admission. As you can imagine, old patients with congestive heart failure often arrived in florid pulmonary edema, and it was not unusual for diabetic patients to be admitted in ketoacidosis. “Mr. Z” was neither in heart failure nor diabetic. However, he did have left buttock and leg claudication and a nonpalpable left femoral pulse. He came with films from an outside aortogram and runoff that showed a short, focal, very tight stenosis in the left common iliac artery. After Mr. Z was prepared and draped for the procedure, Charles Dotter was called to the laboratory for the angioplasty. Because he had not seen the patient until this moment, introductions were made. Charles was a slender wiry man, about 5 feet, 10 inches, with penetrating eyes. To characterize him as intense would be grossly understated. A man of few words, Charles said, “Let’s get started.” He accessed the right common femoral artery and placed From the Dotter Interventional Institute, Oregon Health & Sciences University, 3181 S. W. Sam Jackson Park Road, L605, Portland, OR 97239. Received and accepted November 8, 2014. Address correspondence to F.S.K.; E-mail: [email protected] The author has not identified a conflict of interest. & SIR, 2015 J Vasc Interv Radiol 2015; 26:355–356 http://dx.doi.org/10.1016/j.jvir.2014.11.015
Figure. Left to right, Frederick Keller, Josef Rösch, and Charles Dotter, 1979. (Available in color online at www.jvir.org.)
a pigtail catheter just above the aortic bifurcation. Then he walked over to the patient’s left side and said to me, “Show it to me, Sonny, show it to me!” It took me a few seconds to realize that he wanted me to inject contrast medium into the pigtail catheter so that he could visualize the nonpalpable left femoral artery and stick it under fluoroscopic guidance. (Digital subtraction roadmapping had not yet been developed, and ultrasound-guided vascular access had not yet been described at that time.) Charles tried to access the left common femoral artery several times. Before each attempt he kept uttering, “Show it to me, Sonny!” Finally, after uttering “Show it to me, Sonny” five or six times, he was successful. Charles then advanced a guide wire and catheter across the left common iliac stenosis and used the coaxial dilating catheter set he developed. It consisted of inner 8-F and outer 12-F polytetrafluoroethylene (Teflon) catheters. Follow-up angiography was done through the pigtail catheter in the distal aorta. Satisfied with the results, Charles injected a dose of heparin through the pigtail catheter. For him, the angioplasty was completed, and he left the angiography laboratory. “Sonny” was left to compress the arteries. (Closure devices had not yet been developed.) The good news was Mr. Z. ended up with a strongly palpable left femoral pulse. The bad news was he had a sizable leftsided scrotal hematoma. “Oh well.” It is probably surprising to you how primitive things were by today’s standards. However, it was cutting-edge medicine at the time. Charles Dotter is known as the
356
’
Scrubbing with Charles Dotter
“Father of Interventional Radiology.” He was the individual who formulated and promoted the concept that the “angiographic catheter can be more than a tool for passive means for diagnostic observations; used with imagination it can become an important surgical instrument.” It is amazing to witness the incredible advances that have occurred in interventional radiology over the 39 years that have elapsed since that day. I was very fortunate that my interventional radiology career began in the early days
Keller
’
JVIR
of this wonderful specialty and that I had both Josef Rösch and Charles Dotter as mentors and friends (Fig). Soon I will be doing my last case on my last day as a practicing interventional radiologist. For me, it will be a bittersweet time. I hope that you, the readers of this little anecdote, will have a career in interventional radiology as fulfilling and satisfying as mine was. I also hope that you will continue to keep interventional radiology on the forefront of innovation and medicine.
Scrubbing with Charles Dotter on an Angioplasty Frederick S. Keller, MD January 15, 1976: It was my first case on my first day of my first rotation on “angiography.” I was in my second year of a 3-year diagnostic radiology residency. Interventional radiology as a subspecialty did not yet exist at that time; invasive intraarterial and intravenous vascular procedures were done in the “angiography” or “special procedures” sections of diagnostic radiology departments. The first case I was assigned to that day was “Mr. Z,” an elderly patient who had traveled from Florida to have Dr. Charles Dotter perform his angioplasty. At that time, patients came to Charles Dotter for angioplasties from all over the United States as well as, for that matter, from all over the world. The scenario was as follows: The patient was admitted to the angiography section of the diagnostic radiology department. The resident on the angiography rotation or the angiography fellow took the history, performed the physical examination, and cared for the patient during his or her hospital stay. Enid Ruble, Charles’ longtime administrative assistant, wrote to patients instructing them to stop taking all their medications 3 days before admission. As you can imagine, old patients with congestive heart failure often arrived in florid pulmonary edema, and it was not unusual for diabetic patients to be admitted in ketoacidosis. “Mr. Z” was neither in heart failure nor diabetic. However, he did have left buttock and leg claudication and a nonpalpable left femoral pulse. He came with films from an outside aortogram and runoff that showed a short, focal, very tight stenosis in the left common iliac artery. After Mr. Z was prepared and draped for the procedure, Charles Dotter was called to the laboratory for the angioplasty. Because he had not seen the patient until this moment, introductions were made. Charles was a slender wiry man, about 5 feet, 10 inches, with penetrating eyes. To characterize him as intense would be grossly understated. A man of few words, Charles said, “Let’s get started.” He accessed the right common femoral artery and placed From the Dotter Interventional Institute, Oregon Health & Sciences University, 3181 S. W. Sam Jackson Park Road, L605, Portland, OR 97239. Received and accepted November 8, 2014. Address correspondence to F.S.K.; E-mail: [email protected] The author has not identified a conflict of interest. & SIR, 2015 J Vasc Interv Radiol 2015; 26:355–356 http://dx.doi.org/10.1016/j.jvir.2014.11.015
Figure. Left to right, Frederick Keller, Josef Rösch, and Charles Dotter, 1979. (Available in color online at www.jvir.org.)
a pigtail catheter just above the aortic bifurcation. Then he walked over to the patient’s left side and said to me, “Show it to me, Sonny, show it to me!” It took me a few seconds to realize that he wanted me to inject contrast medium into the pigtail catheter so that he could visualize the nonpalpable left femoral artery and stick it under fluoroscopic guidance. (Digital subtraction roadmapping had not yet been developed, and ultrasound-guided vascular access had not yet been described at that time.) Charles tried to access the left common femoral artery several times. Before each attempt he kept uttering, “Show it to me, Sonny!” Finally, after uttering “Show it to me, Sonny” five or six times, he was successful. Charles then advanced a guide wire and catheter across the left common iliac stenosis and used the coaxial dilating catheter set he developed. It consisted of inner 8-F and outer 12-F polytetrafluoroethylene (Teflon) catheters. Follow-up angiography was done through the pigtail catheter in the distal aorta. Satisfied with the results, Charles injected a dose of heparin through the pigtail catheter. For him, the angioplasty was completed, and he left the angiography laboratory. “Sonny” was left to compress the arteries. (Closure devices had not yet been developed.) The good news was Mr. Z. ended up with a strongly palpable left femoral pulse. The bad news was he had a sizable leftsided scrotal hematoma. “Oh well.” It is probably surprising to you how primitive things were by today’s standards. However, it was cutting-edge medicine at the time. Charles Dotter is known as the
356
’
Scrubbing with Charles Dotter
“Father of Interventional Radiology.” He was the individual who formulated and promoted the concept that the “angiographic catheter can be more than a tool for passive means for diagnostic observations; used with imagination it can become an important surgical instrument.” It is amazing to witness the incredible advances that have occurred in interventional radiology over the 39 years that have elapsed since that day. I was very fortunate that my interventional radiology career began in the early days
Keller
’
JVIR
of this wonderful specialty and that I had both Josef Rösch and Charles Dotter as mentors and friends (Fig). Soon I will be doing my last case on my last day as a practicing interventional radiologist. For me, it will be a bittersweet time. I hope that you, the readers of this little anecdote, will have a career in interventional radiology as fulfilling and satisfying as mine was. I also hope that you will continue to keep interventional radiology on the forefront of innovation and medicine.
![[50 years ago: Charles Dotter and the first percutaneous transluminal angioplasty].](/assets/img/hold.png)
