Chapter

Advancing the TIPS Sheath Through a Difficult Cirrhotic Liver: Pay It Forward Off the Balloon

Adam N. Plotnik and Stephen Kee

in Interventional and Endovascular Tips and Tricks of the Trade

Published on behalf of Oxford University Press

Published in print July 2018 | ISBN: 9780199986071
Published online August 2018 | e-ISBN: 9780199390885 | DOI: https://dx.doi.org/10.1093/med/9780199986071.003.0076
Advancing the TIPS Sheath Through a Difficult Cirrhotic Liver: Pay It Forward Off the Balloon

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  • Clinical Radiology
  • Interventional Radiology
  • Surgery

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The “pay it forward off the balloon” technique for advancing the transjugular intrahepatic portosystemic shunt (TIPS) sheath may be employed during a difficult TIPS case when the interventionalist has already accessed the portal vein but cannot get the standard 10 Fr TIPS sheath through the fibrotic tract into the portal vein to thereby allow placement of a standard TIPS covered stent. In some patients, the fibrotic recoil of the parenchymal hepatic tract can be so severe that the basic balloon dilation maneuver fails. The pay it forward off the balloon technique employs the use of a 6 mm × 4-cm balloon, which is placed through the 10 Fr TIPS sheath and advanced over the wire and across the fibrotic tract into the portal vein.

Chapter.  1106 words.  Illustrated.

Subjects: Clinical Radiology ; Interventional Radiology ; Surgery

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