The recommendations in this article provide a datasupported approach. They are based on the following: (1) a formal review and analysis of recently published world literature on the topic (as listed in MEDLINE); (2) the American College of Physicians’ A Manual for Assessing Health Practices and Designing Practice Guidelines; (3) policy guidelines, including the American Association for the Study of Liver Diseases’ Policy Statement on Development and Use of Practice Guidelines and the American Gastroenterological Association’s Policy Statement on the Use of Medical Practice Guidelines; and (4) the authors’ years of experience in the care of patients with portal hypertension and use of transjugular intrahepatic portosystemic shunt in the management of these disorders. These recommendations are fully endorsed by the American Association for the Study of Liver Diseases and the Society for Interventional Radiology.