E. A and c

“Pre-emptive TIPS” for prevention of recurrent variceal bleeding has been shown to be beneficial for patients with Child Pugh C cirrhosis or those with Child Pugh B cirrhosis with evidence of bleeding on endoscopy. This can also be performed outpatient (“elective TIPS”). Early TIPS in these patients was shown in a study to have less rebleeding (3% vs 50%) and time in the hospital (4 vs 15 days) with superior 1 year survival (86% vs 61%) compared to medical management.

The patient ultimately underwent a retrograde transvenous obliteration via common femoral venous access. A curved 9 Fr sheath was placed at the origin of the left renal vein and a 4 Fr C2 catheter was used with an angled glidewire to select the outflow of the gastrorenal shunt. Further catheter purchase into the shunt allowed passage of a stiff working wire to advance an 8 Fr balloon catheter into the shunt for venography.