TIPS for TIPS: The "Best Chance" Protocol by Dr. John Louie (Stanford)

TIPS for TIPS: The "Best Chance" Protocol

This episode tackles one of the most technically demanding procedures in IR, breaking down Dr. John Louie’s protocol to transform the traditional "blind stick" of a TIPS procedure into a visualized, scientific process.

• The Visualization Crisis: Standard iodinated contrast fails to opacify the portal vein 75% of the time because it washes out with flow. We discuss why CO2 digital subtraction angiography is the superior alternative, achieving an 87% visualization rate by using buoyancy to backfill the portal system.

• The "Targeted Puncture": How using CO2 turns a missed needle pass into a roadmap, allowing you to correct your angle based on visual feedback rather than guessing.

• IVUS as the Great Equalizer: We review data showing that Intravascular Ultrasound (IVUS) significantly reduces radiation and capsular perforations. Crucially, the data shows IVUS benefits inexperienced operators the most, allowing them to match the speed and safety of veterans.

• The Anatomy Hack: Dr. Louie solves the "Parallel Vein" illusion (where the Right and Middle Hepatic veins overlap) with one simple move: Check the Lateral View. The RHV will always be posterior.

• The "Backdoor" (DIPS): When standard access fails, Direct Intrahepatic Portosystemic Shunt (DIPS) is the alternative. We discuss why it's a last resort due to the risks it poses for future liver transplantation.

Tune in to learn how to stop "poking and praying" and start seeing your target.