Treatment of bleeding esophageal varices during pregnancy is a rare clinical dilemma. Primary therapy remains endoscopy and band ligation. Refractory variceal hemorrhage treated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure potentially exposes the fetus to radiation. The present report describes a TIPS procedure performed at 22 weeks gestation with the use of radiation-sparing maneuvers in a patient with recurrent esophageal variceal hemorrhage. The TIPS procedure delivered an estimated fetal dose of 5.49 mSv (0.549 Rad), much less than the dose threshold thought to induce biologic effects and only slightly greater than annual background radiation. The interventional radiologist should not hesitate to perform a TIPS procedure for refractory variceal hemorrhage with use of strategies aimed at minimizing radiation.