Are there any times when you consider alternatives to TIPS?

Referrals & Pre-TIPS Workup with Dr. Emmett Lynskey

Lesson 1

Tell us about how your referral pattern for TIPS has evolved

Lesson 2

How do you work with hepatologists to workup TIPS patients?

Lesson 3

What are the most common indications for tips and what do you see most commonly in your practice?

Lesson 4

Can you explain MELD score on a basic level and what value within MELD is a driver for what you do?

Lesson 5

What is the cutoff MELD score for patients you won't take for TIPS?

Lesson 6

How does the backup of a transplant let you be flexible on your MELD score criteria if the patient has refractory ascites?

Lesson 7

How does the cross sectional help you with TIPS planning?

Lesson 8

Are there any times when you consider alternatives to TIPS?

Lesson 9

Can you talk about the considerations you have the day of the procedure?

Lesson 10

Can you talk about why you want to have the paracentesis the day of?

Basic TIPS Procedure Technique with Dr. Emmett Lynskey

Lesson 11

Can you take us through the beginning steps of how a TIPS is performed?

Lesson 12

What is the next step after you have access and have taken your pressures?

Lesson 13

Can you talk about the different TIPS sets?

Lesson 14

Talk about the needle pass and finding the right access site

Lesson 15

How do you get your wire and sheath through into the portal system?

Lesson 16

Tell us about the portogram and what are you trying to see while doing the dual run?

Lesson 17

How do you size your stent and can you describe stent deployment?

Lesson 18

Can you discuss the gradients and what your goals are?

Lesson 19

Can you talk about embolization after deployment of the TIPS?

Lesson 20

What is your follow up and post procedural care protocol?

Lesson 21

How important is it to counsel the patient’s care-taker or spouse?

Using ICE & Splenic Access for TIPS with Dr. Emmett Lynskey

Lesson 22

When did intracardiac echo (ICE) first get on your radar and how did you overcome the learning curve?

Lesson 23

Tell us how you are using ICE for TIPS.

Lesson 24

Do you need someone else to manipulate the probe for you or are you able to park the probe as you go?

Lesson 25

Describe how you make throws using the ICE probe and select the section of the hepatic vein you want to enter

Lesson 26

How many times did you use the ICE catheter before it became something essential?

Lesson 27

Is ICE helpful in a chronic thrombosis situation and TIPS revisions?

Lesson 28

Are there other situations where the ICE catheter is useful?

Lesson 29

Can you talk about the ABC's of splenic access and also the technical maneuvers that make it easier?

Lesson 30

Can you describe the tactile feel to accessing a splenic vein?

Lesson 31

What wires and sheaths are you using for splenic access?

Lesson 32

What are your steps in terms of accessing the native portal vein or the thrombosed section of the portal vein?

Technique & New Tools for TIPS with Dr. George Behrens

Lesson 33

Can you tell us about your unique portal hypertension practice and referral system for TIPS?

Lesson 34

When working up a patient up for TIPS, what do you specifically get for the procedure?

Lesson 35

Tell us about the first steps of your TIPS, do you start with a paracentesis for ascites?

Lesson 36

What are the next steps after you place your sheath?

Lesson 37

Tell us about why you use CO2 portogram and not ICE guidance.

Lesson 38

After you're set up and ready to make some throws how do you go about it?

Lesson 39

With the new Scorpion needle, how do you have the ability to track anterior rather than just cranial caudal?

Lesson 40

So with a curved cannula and a curved needle tip that adds to directionality, how does this help you move the direction you want to go?

Lesson 41

How does the Scorpion TIPS set give you more steerability and maneuverability when accessing the portal system?

Lesson 42

After parking your glidewire advantage, what's your technique for getting the parenchyma dilated and sheath across?

Lesson 43

After you get the stent deployed and landing zones determined, what next?

Lesson 44

Can you give some rough guidelines for what to do when you have a really elevated portal pressure?

TIPS with ICE Guidance with Dr. Merve Ozen

Lesson 45

What made you decide to bring ICE TIPS into your practice and do you do all of your TIPS with ICE guidance?

Lesson 46

Walk us through the machine that you use for your ICE guidance and how you use it.

Lesson 47

Are there any pitfalls or probe settings that early operators might not do right?

Lesson 48

Why is it important to understand the anatomy and take your time scanning? Which needle do you use and why?

Lesson 49

Can you describe what you are looking for on your ICE image before you stick?

Lesson 50

Any troubleshooting you've encountered with the ICE stick and how do you approach challenging cases?

Lesson 51

Are there situations where you don't use ICE to teach how to do regular tips?

Lesson 52

Why is it important to take your time at the beginning and what should you do if you feel like you aren't on the right trajectory?

Gunsight Technique & Splenic Closure with Emmett Lynskey

Lesson 53

What do you do to determine and optimize a target once you've positioned your catheter in the right portal?

Lesson 54

What kind of snare do you throw up in the right portal and how do you actually get the wire snared?

Lesson 55

Tell us about next steps once you've stuck with a 22 gauge chiba. Do you feed it to the parenchyma a little bit to engage the snare?

Lesson 56

Now that you have your 0.035 system in place, what are the next steps in forming the tips?

Lesson 57

What are the different options for splenic closure?

BRTO for Treating Variceal Bleeding with Dr. Luke Wilkins

Lesson 58

What are the indications for just a routine BRTO?

Lesson 59

In general, which patients are good candidates for TIPS and BRTO?

Lesson 60

How do you use the MELD score and preprocedure imaging for BRTO compared to TIPS?

Lesson 61

For a BRTO do you use moderate sedation or general anesthesia and what are your go-to access tools?

Lesson 62

What do you look for in terms of collaterals and shunts and what is going to change your treatment plan?

Lesson 63

What's your recipe for making your sclerosant and do you leave coils?

Lesson 64

What do you do for follow up for BRTO patients?

Lesson 65

Any pearls or pitfalls from more challenging cases?

BRTO: Beyond the Basics with Saher Sabri

Lesson 66

Can you walk through how you do a routine BRTO

Lesson 67

Can you walk through how you do a routine PARTO?

Lesson 68

How far into the shunt do you want your embolic catheter to be?

Lesson 69

How do you mix your STS plus gel foam concoction, and what is a reproducible fluoroscopic endpoint?

Lesson 70

Do you do this single session and leave coils behind?

Lesson 71

In what patient presentation would you start with BRTO with TIPS?

Lesson 72

Do you do the TIPS first in all of your combined cases?

Lesson 73

Is there ever a situation where you put a TIPS in and have them come back for the BRTO?

Lesson 74

Can you walk me through a situation where you've had to get access through the spleen to get to the splenic vein for embolization?

Lesson 75

What is your setup for trans-splenic access?

Lesson 76

Would you do a BRTO on someone who you know could not get TIPS?

Lesson 77

How did you raise awareness around this new procedure to your referring doctors before they were familiar?

Portal Vein Recanalization with Dr. Riad Salem

Lesson 78

Why do we need to care about portal vein recanalization?

Lesson 79

What does the workup look like for a patient needing portal vein recanalization?

Lesson 80

Once you have the patient on the table, where do you start?

Lesson 81

Can you describe your technique for accessing through the spleen?

Lesson 82

Talk us through challenging access

Lesson 83

How much time do you spend probing and trying to locate the portal vein?

Lesson 84

Are there any troubleshooting techniques for starting out and hitting that snare easier?

Lesson 85

Talk to us about things to be careful about with your wire, and any other pitfalls

Lesson 86

What advantage is there to embolizing varices and what will it do to the portal system flow?

Lesson 87

What do you do when it's time to close your access at the spleen?

Lesson 88

What is your portal vein recanalization post-care and follow up regimen for the patient?

Lesson 89

What are some helpful resources for someone who's been through training and looking to get into complex portal vein recanalization?

TREAT LIVE at Mt Sinai 2024 & 2025 Cases

Lesson 90

TREAT LIVE BRTO Case December 2024

Lesson 91

TREAT LIVE at Mt Sinai Case: TIPS with Portal Recanalization