EARLY occlusion of a transjugular intrahepatic portosystemic shunt (TI
PS) is a frustrating entity that not only detracts from the success of
the procedure, but increases the cost of patient care. One proposed s
ource of TIPS thrombosis is an iatrogenic biliary fistula created duri
ng the initial TIPS insertion (1). We report a case of early TIPS thro
mbosis refractory to simple revision. This occlusion was due to an int
rahepatic duct fistula and was subsequently treated successfully with
a stent-graft.