The transjugular intrahepatic portosystemic shunt (TIPS) is an exciting new addition to the therapeutic armamentarium against portal hypertension. It is currently indicated for salvage of patients with active variceal hemorrhage despite sclerotherapy or where sclerotherapy is not feasible. Its use for recurrent episodes of bleeding despite chronic sclerotherapy and for ascites and hepatorenal syndrome remains experimental. It is contraindicated in patients with right-heart failure and portal vein thrombosis. TIPS is not indicated for primary prophylaxis of variceal hemorrhage or portal decompression prior to liver transplantation. TIPS is associated with its unique spectrum of complications which can occasionally be lifethreatening. Although initial experience with this procedure is encouraging, a great amount of work remains to be done to fully define its role in clinical practice.

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