Since our first clinically successful TIPSS procedure in 1988 numerous steps to improve the safety and methodology have helped to increase the technical and clinical success while the rate of complications could be significantly reduced. In our series of more than 200 patients the technical success rate is more than 95% and the early clinical success rate (< 30 days after TIPSS) 89%, respectively. Early shunt occlusion was found in 1.5% of our patients. 3 months after TIPSS, however, transjugular portography reveals significant shunt stenosis in 46% needing either shunt re-dilatation or additional stent placement. This relatively high rate of re-intervention is being significantly reduced during the further follow-up with a frequency of 17% at a 6 month interval and 6% at a 12 month interval, respectively. The need for re-intervention is strongly associated with liver function and the patients' coagulation status: Child's A patients needed re-intervention substantially more often than those in stage B or C at each given follow-up interval. The decreasing need for re-intervention over time appears to be associated with the formation of an endothelial cell layer on the surface of the shunt tract.