TIPS is the creation of an intrahepatic shunt between the portal and hepatic veins. The primary indications for TIPS are unresponsive acute variceal bleeding; bleeding from gastric varices, ectopic varices and portal gastropathy; and variceal bleeding in patients awaiting liver transplantation. Preliminary reports suggest that TIPS may be useful in other conditions such as resistant ascites, cirrhotic hydrothrorax and hepatorenal syndrome. TIPS has also been successfully placed in a proportion of patients with Budd-Chiari syndrome and portal vein thrombosis. The immediate post-procedure complication rate is low, considering the serious underlying illness of patients undergoing TIPS. However, the main concern in the long-term is stent stenosis or occlusion. Within one year, nearly 50% of patients develop stent dysfunction and a significant proportion of these patients suffer from recurrent variceal bleeding. At present, no clear solution has been found to this problem. It is hoped that stents made of material which is less thrombogenic and which provokes a less exuberant host tissue response may become available. Until then, TIPS should be reserved for complications which are unresponsive to standard therapy and in patients where surgery is considered hazardous.