During recent decades, many image-guided procedures for portal hypertension have been developed, and today, interventional radiology has evolved to become an integral part of therapy. Various procedures are currently available, the choice depending on the etiology and location of disease, the pathoanatomy, and the symptomatology. Those procedures can be categorized into two groups. 1) Interventions to reduce the portal pressure by either direct or indirect methods. This can be achieved with transjugular intrahepatic portosystemic shunt (TIPS), recanalization of the hepatic vein outflow, recanalization of the portal vein and its tributaries, partial splenic embolization, and embolization of arterioportal shunts. 2) Interventions to embolize bleeding varices without altering portal pressure. This can be performed percutaneously or transvenously. This article briefly describes the procedures, their results, and their current status in the treatment of portal hypertension.