A rail and/or anchor system and method for transjugular intrahepatic portosystemic shunt procedures. The system includes a rail and/or anchor line anchorable to surrounding tissue or used as a rail, and configured to guide the displacement of at least one of a needle and an outer sheath. The rail and/or anchor line may include a balloon catheter, and a balloon of the balloon catheter may be configured to selectively anchor the anchor line to surrounding tissue by the balloon being inflated, and unanchor the anchor line to surrounding tissue by the balloon being deflated. The balloon catheter can be stiff so that it can be used as a rail even when not anchored. The balloon catheter may be configured for executing wedge venography, and for measuring pressure at a tip of the balloon catheter while a balloon of the balloon catheter is inflated. The anchor line may include one or more hooks for anchoring the anchor line to surrounding tissue. The one or more hooks may be selectively advanceable and retractable.
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