[TIPS: current and innovative concepts]

Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) has become an established interventional procedure for treating decompensated liver cirrhosis and its complications, such as portal hypertension. Current research focuses on optimizing patient selection and timing to enhance outcomes further. TIPS effectively reduces portal vein pressure, mitigating bacterial translocation and systemic inflammation associated with cirrhosis. This reduction in inflammation has been shown to decrease decompensation events and improve survival rates. However, challenges remain regarding the precise adjustment of the portosystemic gradient (PSG) to balance symptom control with minimizing risks such as hepatic encephalopathy or cardiac complications. The main indications for TIPS include variceal bleeding (especially high-risk patients requiring preemptive TIPS within 72 hours), recurrent ascites, and Budd-Chiari syndrome. Strict patient selection is crucial to maximize benefits while minimizing risks. Emerging evidence highlights the importance of addressing both portal hypertension and inflammation to improve clinical outcomes. In summary, TIPS represents an effective approach to managing complications of liver cirrhosis that improves survival and quality of life for affected patients.