This article overviews principles of portal hypertension and the role of implantation of a transjugular intrahepatic postosystemic shunt (TIPS) in its management. Since TIPS is available for over 30 years, technical achievements have been made and knowledge about indications, contraindications and patient selection has been improved. Recent studies and guidelines may lead to an increase in TIPS implantation rates. This review aims to commemorate the merits and demerits of TIPS in current clinical practice.