Acute bleeding from esophageal varices is a lethal complication in patients with hepatocellular carcinoma complicated by portal vein thrombus. Standard TIPS therapy is often contraindicated in patients with extensive occlusion of the main portal vein or severe liver dysfunction. The article describes the first clinical application of percutaneous portal-central venous bypass (PPCV) in a 5-year-old patient with decompensated cirrhosis and extensive PVTT. The patient had life-threatening refractory variceal bleeding unresponsive to endoscopic therapy and was ineligible for TIPS due to tumor thrombus and instability. PPCV was performed by puncturing the portal vein under ultrasound guidance and connecting an extracorporeal shunt to the existing central subclavian catheter. The procedure was technically successful, the portal pressure decreased from 40.6 mmHg to 18.8 mmHg, hemostasis was achieved within 24 hours, and the patient was stable for 2 weeks until discharge. There was no recurrent bleeding or procedure-related complications, although the patient succumbed to tumor progression 2 months later. PPCV is a simple rescue therapy to reduce portal pressure in high-risk patients with HCC and PVTT ineligible for TIPS.