Join Dr. Ziv Haskal as he presents a case-based review highlighting the use of the Liverty™ TIPS Stent Graft in the creation of a Transjugular Intrahepatic Portosystemic Shunt (TIPS).
We've chosen a 10 by 7 liberty device, 7 centimeter covered, 2 centimeter bare. I'm going to flush the device. The device has been prepared. And the last thing I'm going to do is wipe the sleeve to activate it. And the device is ready to go. I'm going to begin introducing the Liberty device into the sheet. We've demonstrated that the device can be introduced without the sheath in place. The next step is to assess the positioning. We're demonstrating that we're able to inject around the device through the outer 10 French liberty sheath to determine where to put the leading end of the device. Which I think really is right there. So where I have my marker band is really where I want that transition to be where we have the large portal band. I'm going to begin the deployment of the device by retracting the sheath, after which I'll give it back to you. OK, I can reassess my position. I'm satisfied with that. I could potentially push it in the slightest bit like that. And now I'm ready to begin deploying the leading end. So the first step is number one. I'm gonna release the number one button. Next thing is I'm going to grasp the thumb roll or the thumb wheel which has a 2 and a 4. I'm in step 2 right now and then I'm going to slowly unroll the leading end of the device. Switched to my usual hand and I'm holding the shaft of the device with my Leading hand, the device is starting to deploy. I've moved it back very slightly to park it into the position that I want. And At this point, the leading bear end has been deployed and I feel a hard stop at the thumb wheel. So I'm going to reassess the position of the device, and I have it at the portal entry set just as I wish. Now we're ready to complete the deployment of the device. So in order to move to the final step, I'm going to start to release the covered end, which means pressing button number 3. So that's a hard press. And an audible click. The button is depressed, and then I get to use the thumb wheel again. You're holding the sheath. I grasp the deployment catheter. And now I'm going to slowly roll the device back. Which is releasing a covered portal end. Which is naturally a little constrained at the fibrotic portal entry site. And the device is free. Now we're going to do a slow removal of this device as it's backed out. So we're gonna perform a post dilatation, introduce the 7 balloon. 16 Reinflate here. In a moment we're going to remove the 7 balloon and introduce the 8 balloon just to do zone A at the transition of the covered end. Deflate. We're going to perform the 8 balloon dilatation of zone A. 16 We're gonna hold this dilatation for about 25 seconds minimum so we have effectively right now created a 7 millimeter diameter right hepatic to right portal vein shunt portal systemic shunt. We're gonna do the final portal venograms. Our patient is a 64-year-old man with uh marked portal hypertension and severely refractory ascites. Today we have created a 7 millimeter diameter shunt using a Liberty 7 centimeter covered 2 centimeter bear end device.
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