Development of Transjugular Intrahepatic Portosystemic Shunt

Abstract

The transjugular intrahepatic portosystemic shunt (TIPS) was developed experimentally in canines in the late 1960s. It was one of the early interventional radiologic techniques. Although there was some science, serendipity played a major role in the creation of TIPS. It was a natural process, and here is the story. I was a diagnostic radiologist in the Central Military Hospital in Prague, Czechoslovakia, for 16 years, beginning in 1951. I performed my first angiographic procedure, splenoportography, in 1954. After performing more than 1,000 procedures, writing many papers and one book, and creating a teaching movie on splenoportography, I became quite familiar with the portal circulation. After our hospital in Prague opened a new angiographic room in 1957, I started doing visceral angiography and gained additional knowledge about the liver, pancreas, and spleen. Although I performed clinical research and published many papers when I was in Prague, I had not been exposed to any basic animal research. This situation abruptly changed when I came to the United States in 1967 at the invitation of Charles Dotter. Coming to the University of Oregon Medical School for a 1-year research fellowship was a fortuitous move for me. Charles had an angiographic room for animal research, where I worked on some of his research ideas. But mainly, through his ingenuity and creativity, he became my persuasive teacher. He always emphasized that I should think about potential interventional treatment during diagnostic procedures. Also, he stressed that I should always consider improving existing or developing new interventional tools. After 1 year with Charles, I was ready to become an active interventionalist.