Background: Transjugular intrahepatic portosystemic shunt (TIPSS) outcomes in patients with moderate-to-severe pre-existing kidney disease (PKD, stages G3a–G4) remain poorly characterized. This study aimed to identify potential predictors of mortality specifically in patients with an eGFR 15–59 mL/min/1.73 m². Methods: We retrospectively analyzed 68 cirrhosis patients with PKD (eGFR < 60 mL/min/1.73 m²) undergoing a TIPSS between April 2021 and April 2024. Clinical outcomes, renal function changes, and 12-month survival were assessed. Statistical analyses included paired t-tests with false discovery rate adjustment and Kaplan–Meier survival analysis to identify potential predictors of mortality. Results: The cohort (mean age 61.0 ± 8.3 years, 83.8% male, 79.4% with PKD G3a–G3b) showed modest improvement in renal function (creatinine 1.93 to 1.75 mg/dL, p = 0.031), though this biochemical change did not predict survival. Overall mortality was 36.8% (95% CI: 25.4–49.5%) at mean follow-up of 6.7 months. Traditional severity scores (MELD, Child–Turcotte–Pugh) showed no significant association with survival (p > 0.05 for all comparisons). In exploratory analyses, mortality was significantly higher in patients with the following: (1) uncontrolled diabetes before a TIPSS (55.2% vs. 25.9%; RR 2.35, 95% CI: 1.08–5.15, p = 0.032); (2) post-TIPSS infection (70.0% vs. 31.0%; HR 5.44, 95% CI: 1.54–19.23, p = 0.009); and (3) post-procedural cardiac events (85.7% vs. 31.1%; p = 0.005). These associations persisted after false-discovery rate adjustment but require prospective validation given the modest sample size and wide confidence intervals. Conclusions: In this exploratory single-center study of patients with moderate PKD undergoing a TIPSS, we observed associations between mortality and pre-TIPSS poorly controlled diabetes, infections, and cardiac events. These hypothesis-generating findings suggest potential areas for future research. Prospective multi-center studies are needed to validate these associations and determine whether interventions targeting these factors improve outcomes.

Acute nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency associated with significant morbidity and mortality. The most common cause of NVUGIB is peptic ulcer disease, but the differential diagnosis is diverse. The management of NVUGIB begins with resuscitation of the patient followed by early upper gastrointestinal (GI) endoscopy for diagnosis and initial treatment. Endovascular interventions have largely replaced surgery for the cases where endoscopic therapy fails, reflecting a paradigm shift toward minimally invasive and effective management strategies. It is essential to have a comprehensive understanding of arterial anatomy, common vascular variations, and different collateral pathways for successful endovascular management of NVUGIB. This review provides a thorough overview of NVUGIB, encompassing the management algorithm, imaging protocol, anatomical considerations, embolization techniques, types of embolic agents, and potential complications that interventional radiologists should consider when managing cases of NVUGIB.