Abstract: A percutaneous pathway system and method are disclosed with a sheath, a spacer upon the sheath, a needle parallel within the sheath, the needle is sheathed so the needle is not exposed beyond the spacer, a passthrough wherein the needle is retractable within the passthrough, the needle is not exposed beyond the spacer while retracted, the needle is extendable beyond the spacer to suitably acquire a target, the spacer provides a balloon, and an insufflation port on the sheath to insufflate the balloon of the spacer. A method for commencing an interventional radiology procedure provides inserting a needle, a balloon spacer, and a sheath percutaneously without initially extending the needle; expanding the balloon spacer while simultaneously maintaining the needle in sheathed position within the sheath; and subsequently unsheathing the needle through the sheath percutaneously.