As the name suggests, portal vein thrombosis refers to thrombosis occurring in the main trunk of the portal vein, superior mesenteric vein, inferior mesenteric vein or splenic vein. According to our department’s long-term observation of a large number of patients with cirrhotic portal hypertension, about 4-5% of patients with cirrhotic portal hypertension have combined portal vein thrombosis, but most of them have no symptoms, and a small number of patients have abdominal distension and abdominal pain, and it is very rare that the portal vein is completely obstructed and requires emergency surgery for portal vein dissection to remove the thrombus. According to our hospital data, the incidence of portal vein system thrombosis after splenectomy for portal hypertension is less than 10%, but of course the causes of portal vein system thrombosis are complex. The main cause of portal hypertension in liver cirrhosis is the increase of portal vein pressure, the thinning of portal vein system vessel wall and the dilatation and tortuosity of vessels, resulting in the reduction of hepatic blood flow in portal vein and its branches and the slowing down of blood flow speed resulting in the vortex flow and the formation of platelet accumulation and thrombosis. The main treatment method is anticoagulation and thrombolysis. For those who are ineffective in thrombolysis, in addition to surgery, intrahepatic portosystemic shunt surgery (TIPS) can be performed through intervention to change the hemodynamic state of the portal system to treat and prevent thrombosis of the portal system, which can reduce the pressure of the portal system and prevent and treat bleeding from ruptured varices in the esophagogastric fundus. Recently, our department worked closely with the radiology department to complete TIPS treatment for a patient with cirrhotic portal hypertension combined with portal vein system thrombosis who failed thrombolytic therapy, and achieved satisfactory results. The patient was a 38-year-old female with a 10-year history of hepatitis and 1 year of recurrent vomiting of blood and black stools. Endoscopic examination revealed severe esophageal varices (Figure A). After 4 times of endoscopic ligation treatment for 1 year, the esophageal varices were eradicated, but examination revealed a 1.5*2 cm venous thrombus in the main trunk of the portal vein, and after anticoagulation and thrombolysis treatment, it was found that the thrombus in the main trunk of the portal vein remained unchanged, and a new venous thrombus had formed in the small branch of the superior mesenteric vein. Our department and radiology department decided to treat the patient with transjugular intrahepatic portal shunt with stent implantation (TIPSS). After intraoperative indirect imaging of the portal vein confirmed that there was no malformation of the intrahepatic portal vein, the right internal jugular vein was cannulated through the right hepatic vein to penetrate the left portal branch, and the stent with membrane was implanted after expansion. On review 5 days after surgery (Figure B), there was no thrombus in the portal venous system and the branches of the tortuous dilated portal vein were narrowed, and the patient was discharged without any complications. Figure A esophageal varices before treatment Figure B TIPSS completion From the previous literature, thrombosis of the portal venous system was regarded as a contraindication to bypass surgery and TIPS surgery. In recent years, a few domestic experts have made bold attempts to break the traditional concept and provide a new treatment pathway for portal vein thrombosis in cirrhotic portal hypertension. There is no doubt that this method is useful for the treatment and prevention of small amounts of thrombosis in the portal vein system, but further research and case accumulation are needed to determine whether the treatment of large amounts of portal vein thrombosis will cause extensive pulmonary artery embolism. Of course embolism of the terminal pulmonary artery does not necessarily have a great impact, because the lung tissue has a dual blood supply from the bronchial arteries in addition to the pulmonary artery supply. The extent to which portal vein embolism may become a contraindication to surgery, or whether other methods of filtering out or aspirating these emboli may make this method a very safe routine treatment for portal vein thrombosis, are questions that are being or have been considered by researchers.