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The TIPS device is used to combat the downstream effects of portal hypertension. Patients who have experienced esophageal variceal bleeding that has not been controlled via medical or endoscopic management may benefit from the insertion of a TIPS. Patients who have recurrent worsening ascites that is not improved with traditional medication and diet management also may be candidates for insertion. TIPS may be similarly beneficial in extravascular shifts causing hepatic hydrothorax refractory to medical management.

Hepatorenal syndrome occurs when cirrhotic changes of the liver lead to poor perfusion. Response of vasoactive hormones causes vasodilation of the splanchnic circulation and compensatory vasoconstriction of renal arteries leading to increasing renal failure. Some effect of fluid shifts of increased ascites may also play a role in renal hypoperfusion, and there is some suggestion that TIPS may reduce these shifts leading to improvement in renal function.