As the name suggests, portal vein thrombosis refers to blood clots 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 tracking observation of a large number of patients with cirrhosis and portal hypertension, about 4-5% of patients with cirrhosis and portal hypertension have portal vein thrombosis, but most of the patients do not have any symptoms, and a small number of patients have symptoms of abdominal distension and abdominal pain, and it is very rare to see the patients who have blood in the stool or bloody ascites with complete obstruction of the portal vein and need emergency surgery to remove the thrombus with portal vein incision. Portal hypertension patients after splenectomy is relatively more, outside the hospital reported more than 20%, according to our hospital data, portal hypertension after splenectomy portal vein system thrombosis rate of less than 10%, of course, the causes of thrombosis of the portal vein system is complex. Cirrhosis portal hypertension is mainly due to the elevated portal pressure, portal vein system blood vessel wall thinning, vascular expansion and tortuous, resulting in the reduction of hepatic blood flow to the portal vein and its branches and slowing down of blood flow velocity caused by eddy currents resulting in the accumulation of platelets and the formation of thrombus. The main treatment is anticoagulation and thrombolysis. For those who are not effective in thrombolysis, in addition to surgery, TIPS can also be used to change the hemodynamic status of the portal vein system to treat and prevent thrombosis of the portal vein system, which can reduce the pressure of the portal vein system, and prevent and treat the rupture and bleeding of the varices of 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 thrombosis of the portal vein system who failed thrombolytic therapy, and achieved satisfactory results. The patient was a 38-year-old woman with a 10-year history of hepatitis and recurrent vomiting of blood and black stools for 1 year, who came to our hospital. Endoscopic examination found severe esophageal varices (Figure A), after 1 year 4 times endoscopic ligation treatment, esophageal varices veins to achieve radical cure, but the examination found that the main trunk of the portal vein there is a 1.5 * 2cm vein embolus, anticoagulation thrombolysis treatment after review, found that the main trunk of the portal vein thrombus is still unchanged and the small branch of the superior mesenteric vein has been formed a new venous thrombus. Our department and radiology department decided to treat this patient with transjugular intrahepatic portosystemic shunt with stent implantation (TIPSS). After the intraoperative indirect portal vein angiography 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 vein branch, and a membrane stent was implanted after dilatation. The intraoperative portal vein pressure measurements before the channel was opened and after the stent was placed were 46.8 cmH2O and 24.5 cmH2O, respectively, with a significant decrease in the pressure in the portal vein system. On review 5 days after the operation (Figure B), no thrombus was seen in the portal venous system and the tortuous dilated portal vein branches were narrowed, and the patient was discharged from the hospital without any complication. From the previous literature, thrombosis in the portal venous system was regarded as a contraindication to shunt surgery and TIPS surgery. In recent years, a few experts in China have made bold attempts to break the traditional concepts and provide a new therapeutic pathway for the treatment of portal vein thrombosis in cirrhosis with portal hypertension. This method for the treatment and prevention of a small amount of thrombus in the portal vein system is indisputable, whether the treatment of a large number of portal vein thrombosis will cause extensive pulmonary embolism should continue to be further research and case accumulation. Of course, pulmonary terminal artery embolism does not necessarily have a great impact, because the lung tissue in addition to the pulmonary artery blood supply has a dual blood supply from the bronchial artery. The extent to which portal vein emboli can have a major impact and become a contraindication to surgery, or the use of other methods to filter out or aspirate these emboli so that this method becomes a very safe and routine means of treating portal vein thrombosis, are all questions that researchers are considering or have already been considering.