The snared wire (black arrow) is now used as a “through and through” access from the percutaneous transhepatic needle to the left internal jugular vein. The needle tip (black arrow head) is retracted just proximal to the right portal vein entry. The tip of the introducer sheath (white arrow) placed via the left internal jugular vein is now advanced over the “through and through” wire into the right portal vein. A graduated pigtail catheter (white arrow) is also advanced through the introducer sheath next to the “through and through” wire and directed to the superior mesenteric vein via the main portal vein using standard angiographic techniques. 113 × 125 mm (150 × 150 DPI)