Advancing the TIPS Sheath Through a Difficult Cirrhotic Liver: Pay It Forward Off the Balloon
Keyword(s):
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.
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