Transjugular intrahepatic portosystemic shunt (TIPS) has become a standard therapy for complications of portal hypertension. The key to maximizing the therapeutic efficacy of TIPS lies in balancing the reduction of portal hypertension-related complications (such as rebleeding and ascites) against the risk of complications from excessive shunting (such as hepatic encephalopathy and liver function deterioration). Given the significant heterogeneity among patients, including the etiology of cirrhosis, hepatic reserve function, and comorbidities, traditional “one-size-fits-all” shunting strategy has proven insufficient. Therefore, the concept of individualized planning for intrahepatic portosystemic shunts has emerged. This strategy aims to achieve personalized and precise shunting through careful patient selection, optimized hemodynamic target setting, controlled shunt diameter, and integrated adjuvant therapies.