1. Portal Interventions SuperCourse Intro

    1. Tell us about how your referral pattern for TIPS has evolved

    2. How do you work with hepatologists to workup TIPS patients?

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

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

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

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

    7. How does the cross sectional help you with TIPS planning?

    8. Are there any times when you consider alternatives to TIPS?

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

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

    11. CME/CE Reflection: Module I

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

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

    3. Can you talk about the different TIPS sets?

    4. Talk about the needle pass and finding the right access site

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

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

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

    8. Can you discuss the gradients and what your goals are?

    9. Can you talk about embolization after deployment of the TIPS?

    10. What is your follow up and post procedural care protocol?

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

    12. CME/CE Reflection: Module II

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

    2. Tell us how you are using ICE for TIPS.

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

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

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

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

    7. Are there other situations where the ICE catheter is useful?

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

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

    10. What wires and sheaths are you using for splenic access?

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

    12. CME/CE Reflection: Module III

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

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

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

    4. What are the next steps after you place your sheath?

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

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

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

    8. 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?

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

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

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

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

    13. CME/CE Reflection: Module IV

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

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

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

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

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

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

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

    8. 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?

    9. CME/CE Reflection: Module V

About this course

  • 99 lessons
  • 5 hours of content
  • Earn up to 9 CME/CE credits