Portal vein (PV) thrombosis (PVT) is the formation of a blood clot in the portal vein, which can affect intra- or extrahepatic segments of the portal vein and can extend into its tributaries, including the splenic and mesenteric veins. PVT can progress from partial occlusion of the lumen to complete blockade of portal venous flow. In cirrhotic patients, PVT is most closely associated with slow or static portal venous flow relating to outflow obstruction from cirrhosis. Conversely, PVT in non-cirrhotic patients is most commonly caused by a hypercoagulable disorder or local thrombotic factor (e.g., inflammation or infection). Treatment guidelines recommend anticoagulation as first-line therapy for PVT, though full recanalization rates are low. If patients progress on anticoagulation, have evidence of bowel ischemia, or progress to chronic thrombosis and develop other sequalae of portal hypertension (e.g., variceal bleeding), endovascular intervention may be warranted. Portal vein recanalization and transjugular intrahepatic portosystemic shunt placement (PVR-TIPS) has been shown to be effective at facilitating transplantation in cirrhotic patients with PVT and controlling the sequelae of portal hypertension and chronic thrombosis in non-cirrhotic patients.