The transjugular intrahepatic portosystemic shunt (TIPS) has become an important therapeutic tool in the treatment of portal hypertension and its complications. Because of its relatively low cost and noninvasive nature, sonography plays a key role in preprocedure assessment and postprocedure follow-up. Before the procedure, thorough gray-scale sonographic evaluation of the hepatic parenchyma and biliary tree, and Doppler evaluation of the relevant vasculature should be performed. A baseline sonogram should be obtained within a few days of TIPS placement to serve as a basis for comparison for subsequent surveillance studies. Signs of TIPS dysfunction include complete lack of flow in the shunt, a focal velocity gradient in the stent or in the draining hepatic vein, or a drop in flow velocity compared to the baseline examination.