The procedure is performed under local anesthesia, via a femoral venous puncture, following which access is gained into the culprit shunt (most commonly being a splenorenal, flexible tube with a tiny balloon at one end) through a vein in your thigh or neck and guide the catheter to the liver using fluoroscopy for guidance. The catheter is then directed to the gastro renal or gastric aval shunt and the balloon is expanded to block the shunt.

The interventional radiologist will then perform venography, which is a type of imaging technique in which X-rays are used to see the vessels clearly. This will allow the interventional radiologist to confirm exactly which vessels need to be treated and if any other abnormal or dilated vessels have not previously been identified. Medication will then be injected into the dilated vessels through the catheter until they are completely filled. This medication will remain in the vessel for a short period, and will then be removed under fluoroscopy.

Another venography will then be performed, to confirm that the blood flow in the shunt has stopped. Finally, the balloon will be deflated and the interventional radiologist will withdraw the catheter.