A percutaneous transjugular, intrahepatic portacaval shunt was created by means of a combined jugular and transhepatic approach. In the hepatic tissue track joining the portal and hepatic veins balloon-expandable stents were placed. Two of three patients with life-threatening variceal bleeding and Child C liver cirrhosis benefited from the procedure. One patient in severe hepatorenal failure prior to the procedure died 11 days after the shunt procedure of pulmonary complications. This procedure may be a promising alternative to current therapy in high-risk patients with esophageal bleeding.