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. Author manuscript; available in PMC: 2015 Nov 1.
Published in final edited form as: Clin Liver Dis. 2014 Aug 27;18(4):853–876. doi: 10.1016/j.cld.2014.07.006

Figure 7. TIPS Procedure with ‘Gunsight Technique’.

Figure 7

A: Intravascular US has been placed in the IVC and percutaneous access into the portal system has been obtained and confirmed with an injection of contrast through the needle.

B: After puncturing through loopsnares in the right portal vein and IVC from a second percutaneous access, the wire was pulled through the IVC sheath and the tract between the two sheaths is being angioplastied with a small diameter balloon.

C: The wire was pulled into the portal vein and advanced into the splenic vein from above and the tract is now being dilated to 8mm.

D: Completion venogram through the pigtail catheter demonstrating appropriate flow from the portal vein through the TIPS shunt into the right hepatic vein and right atrium.