Complications of transjugular intrahepatic portosystemic shunt (TIPS) in the era of the stent graft – What the interventionists need to know?

•Major TIPS-related complications occur only in 3-5% of cases that warrant timely intervention.•The interventional radiologist should follow the necessary precautions to avoid those complications.•Presently, TIPS dysfunction is often due to a variety of technical errors and mechanical causes, thus proper stent deployment is critical.•TIPS revision often requires a combination of thrombolytics, mechanical thrombectomy, and angioplasty ± additional stenting. Transjugular intrahepatic portosystemic shunt (TIPS) is created between a hepatic vein (HV) and the portal vein (PV) to alleviate the symptoms of portal hypertension. Despite high procedural success rates, a myriad of complications may occur at every step of TIPS creation. These complications may be attributable to the procedure itself or the shunt. Portal vein puncture is the most challenging and rate-limiting step, with extrahepatic portal vein puncture being the most devastating tabletop complication. Hepatic encephalopathy is the most common shunt-related complication after TIPS. Unlike bare metallic stents, covered stents have a longer patency rate and lower incidence of TIPS dysfunction. Most of the TIPS dysfunction that occurs with stent-grafts is due to technical errors and mechanical factors. TIPS revision often requires a combination of angioplasty, mechanical thrombectomy, and thrombolytics with a need for additional stenting in some cases. This review article focuses on procedure and shunt-related complications, as well as preventive and management strategies.