The transjugular intrahepatic portosystemic shunt (TIPS) is a new interventional radiology procedure which may be assisted by modern ultrasound techniques (US). Color-Doppler US can be used for patients selection, during TIPS and in the follow-up. In a 20-month period, 71 patients were examined: 3 of them were excluded because of the absolute contraindications shown by US; in 14 of the remaining 68 patients, US demonstrated relative contraindications, such as hepatocellular carcinoma, partial portal vein thrombosis and right internal jugular vein occlusion. During the maneuver, US helped to select the most adequate veins for shunt creation and was especially useful in guiding portal vein puncture, thus allowing technical success to be achieved in 65/68 patients. The mean number of passes per patient was 2.7 and no procedure-related complications were observed. US was also used to investigate TIPS patency the day after the maneuver and to monitor shunt function during the follow-up. Color-Doppler US correctly diagnosed both 3/65 early occlusions and 9/65 late stenoses; in particular, in 18/65 patients US showed gradual flow reduction through TIPS, but clinical and endoscopic findings of malfunction appeared only in 9/65 patients whose mean reduction rates exceeded 50% at Doppler US.