We visualized and located the portal and hepatic venous systems before and during the procedure of transjugular intrahepatic portosystemic stent shunt (TIPSS) with color Doppler ultrasonography instead of X-ray in 23 cases in our hospital since November 1993. TIPSS was performed under US guidance, and had the lowest frequency of failure. The gastroesophageal hemorrhage stopped immediately with less complication, the ascites was alleviated. US assisted TIPSS is a safe and simplified procedure.