TIPS University Junior Year: Advanced Techniques, ICE, and Splenic Access

In this episode, Dr. Emmett Lynskey joins Dr. Chris Beck for the third edition of TIPS University to discuss intracardiac echo (ICE) and splenic access in TIPS procedures. We discuss the learning curve associated with ICE and Dr. Lynskey tells us about the early challenges he faced when learning this technique.

We share why using ICE is helpful in TIPS and how to set up the procedure, depending on the type of access you want. We explain how to get a more medial throw by getting the catheter closer to the portal vein, and we discuss how to torque the needle for different throws. We discuss making throws using an ICE probe and why ICE is helpful for acutely thrombosed TIPS revisions. Dr. Lynskey tells us about some other good uses for the ICE catheter.

We discuss splenic access, and we review the conditions that allow for safe splenic access. We explain how to do the ultrasound evaluation anterior to the probe. Dr. Lynskey shares why he dedicates one hand for the wire and one hand for the ultrasound, and he tells us how he picks the sheaths and wires that he uses to get splenic access. We discuss how to know that you have opened up the splenic vein.