BACKGROUND: Proposed in the early 1980s as a solution for managing complications of portal hypertension, the percutaneous creation of transjugular intrahepatic portosystemic shunt has consistently gained a central role. Increasingly lower complication rates have been observed thanks to improvements in both technologies and the skills of interventional radiologists. PURPOSE: This document is aimed at interventional radiologists and provides best practice recommendations for transjugular intrahepatic portosystemic shunt creation, describing patient selection, intraprocedural management and follow-up, in addition to recommendations in paediatric settings. METHODS: The CIRSE Standards of Practice Committee established a writing group consisting of seven European clinicians with recognised expertise in the creation of transjugular intrahepatic portosystemic shunt. The writing group reviewed the existing literature performing a pragmatic evidence search using PubMed to select relevant publications in the English language and involving human subjects, preferably published from 2009 to 2024. The final recommendations were developed by consensus. RESULTS: TIPS creation has an established role in the successful management of portal hypertension and its complications. This Standards of Practice document provides up-to-date recommendations for patient selection, materials, its safe performance, and follow-up with complications management.

Department of Diagnostic and Interventional Radiology University Hospital Bonn Bonn Germany

Department of Diagnostic Medicine and Radiology Interventional Radiology Unit Azienda Policlinico Universitario Policlinico Umberto 1 Rome Italy

Department of Diagnostic Medicine and Radiology Interventional Radiology Unit Sapienza University of Rome Rome Italy

Department of Radiology University Hospital Charles University Faculty of Medicine Hradec Kralove Czech Republic

Department of Vascular and Interventional Radiology François Mitterrand University Hospital Dijon France

Paris Saclay University Faculty of Medicine AP HP Pediatric Radiology Department Bicêtre Hospital Reference Center for Vascular Diseases of the Liver FSMR Filfoie ERN Rare Liver FHU Hepatinov Biomaps UMR 9011 CNRS INSERM CEA Le Kremlin Bicêtre France

Radiology Services IRCCS ISMETT Palermo Italy

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