How is TIPS performed?

1. Vascular access is achieved via the right internal jugular vein.
2. A catheter is advanced into a branch of the hepatic vein.
3. The wedged hepatic pressure is obtained.
4. An image of the portal vein is attained via reflux of contrast through the sinusoids.
5. A Colapinto needle is advanced into the hepatic vein and passed through the liver parenchyma.
6. Suction is applied to the needle as it is slowly withdrawn. When there is blood return, a contrast injection is made to confirm that the needle tip is in a branch of the portal vein.
7. A guidewire is passed into the portal vein.
8. A balloon is used to dilate the tract in the parenchyma.
9. A covered stent is placed, creating a shunt between the branches of the portal vein and the hepatic veins.