Percutaneous treatment of patients with variceal hemorrhage began with transhepatic variceal embolization. These procedures proved to be ineffective as the absolute portal pressure remained elevated and varices recanalized with subsequent rebleeding. Transjugular intrahepatic portosystemic shunts (TIPS) promised the ability to effectively decompress the portal system without the need for general anesthesia. Initial enthusiasm for the procedure has waned as intrahepatic shunt durability proved to be less than adequate. Although it remains a powerful tool, TIPS is not a first line treatment for patients with variceal bleeding.
