Figure 10g. Construction of a homemade reduced stent-graft for placement within a TIPS stent. (a) A 4-mm thin-walled e-polytetrafluoroethylene (PTFE) covering was attached to a Palmaz 394 stent. (b) Graft material was sewn to the cross-struts at both ends with a 5-0 prolene suture after the graft was pre-dilated to 6 mm. (c) Stent was crimped on a 6-mm x 8-cm opta-LP (Cordis, Miami Lakes, Fla) balloon and placed through an 11-F peel-away sheath into a 35-cm-long 10-F sheath. (d) A 30-cm-long 12-F sheath (arrows) was then manipulated through the TIPS. (e) Preloaded stent (advanced to the front of the 10-F sheath) (arrows) was then placed so that the leading end of the graft would be near the portal vein entry site. (f, g) Entire device was dilated to 6 mm in this location, and then a 10-mm x 2-cm balloon was used to flair the leading and trailing ends until a seal was obtained. (h) TIPS venogram obtained through the sheath demonstrates the hourglass configuration of the stent-graft, with the dead space (arrows) becoming entirely excluded. Accurate PSG measurements were subsequently made.