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The TIPS creates an artificial channel between the portal vein and the hepatic vein, thereby decreasing the resistance of blood flow returning to the systemic circulation. Placement of a TIPS is performed with interventional radiology.

Preferably, access occurs through the right internal jugular vein; however, the left internal jugular vein may be used as well. A vascular sheath is introduced and placed into the intrahepatic inferior vena cava. In most cases, the right hepatic vein is isolated and then the radiologist identifies the right portal vein. The shunt is introduced by cannulating the right portal vein from the right hepatic vein. Using the sheath introduced via the jugular access, a needle is passed into the right portal vein. Contrast is used to confirm placement of the needle tip. A wire is passed through the portal vein, and the fibrotic liver tissue is dilated with a small‐caliber balloon. A stent is passed over the wire between the hepatic vein and the portal vein, and as the original vascular sheath is withdrawn, the stent opens. It is then balloon dilated to an appropriate width based on measurements of portal venous pressure.