A plumber for blood vessels

When the American radiologist Charles Dotter needed new catheters for his research in 1963, he speculated that, if none were available, physicians could build catheters themselves from guitar strings, VW speedometer cables, or a piece of intercom cable found in a wastebasket, for example. Indeed, while attending the Annual Meeting of the Radiological Society of North America, Dotter borrowed a blowtorch, disappeared to his hotel room, and emerged the next morning with ten “beautifully made” catheters. Charles Dotter’s love of handicrafts probably also gave rise to his motto: “If a plumber can do it to pipes, we can do it to blood vessels.”

Yet which aspect of a plumber’s work did Dotter believe a radiologist could replicate? And what does it have to do with catheters? In the technique known as angiography, the radiologist uses a catheter to inject a contrast agent that will visualize “hollow” vessels such as arteries and veins. In the resulting X-ray image, the contrast agent stands out from surrounding tissue as either darker or lighter shadows. Multiple X-ray images taken in quick succession allow the physician to observe where the circulation is disrupted by the narrowing of a blood vessel, for example. Prior to 1963, this narrowing could only be treated using a scalpel and a needle and thread – but then Dotter witnessed an event that would transform the world of vascular therapy forever.

As Dotter prepared to perform an angiogram on a patient with a narrowed renal artery, he accidentally dislodged the blockage with the catheter, allowing blood to flow freely again – as the X-ray images clearly showed. Dotter subsequently decided to dedicate his entire career to “catheter therapy.” The first patient to be treated with the new technique deliberately was Laura Shaw, an 82-year-old woman whose left foot had been in pain for weeks. The tissue had turned black and seemed to be wasting away day by day. All of her doctors recommended amputation – but Shaw stubbornly refused. When Dotter was eventually brought in to examine her, he identified the cause of her suffering: The artery in her left thigh was almost completely obstructed, and Dotter decided to use a catheter to unblock it. After a few minutes, the foot was warm and blood was flowing all the way down to the toes again. A week later, the pain had disappeared – and three years down the line, just before her death, Shaw famously said she was “still walking on [her] own two feet.”

Dotter’s pioneering work ultimately gave rise to the medical discipline that we now call interventional radiology. Running to a length of approximately 100,000 kilometers, the human vascular system allows modern physicians to access all of the body’s organs. For example, they can use millimeter-thick catheters to open up blocked vessels in the brain, to treat internal bleeding, or to insert stents in order to stabilize narrowed coronary vessels. To assist radiologists in these minimally invasive interventions, we’ve developed numerous specialized angiography systems over the course of our company history. Physicians can view three-dimensional images of the patient’s anatomy directly at the operating table in order to gain vital information during an intervention. The “therapy of tomorrow” is also starting to take shape: Our systems now allow physicians to deliver minimally invasive therapies with robotic assistance without having to stand at the operating table. Physicians sit in a radiation-shielded workstation or in the operator room and use a set of joysticks and touchscreen controls that translate the physician’s movements into device control.