TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT - HISTOLOGIC AND IMMUNOHISTOCHEMICAL STUDY OF AUTOPSY CASES

Purpose: To assess the histologic findings associated with stenosed an d occluded transjugular intrahepatic portosystemic shunt (TIPS) tracts . Methods: Four TIPS tracts within three autopsy livers were histologi cally studied for vascular components by routine staining and immunohi stochemical staining, TIPS had been performed for bleeding from esopha geal varices in patients with cirrhosis of the liver. Results: Two TIP S, examined on days 4 and 53, showed occlusion by fibrin thrombus. In the former, no endothelial cells were detected, but coagulative necros is of hepatocytes was found in the surrounding liver. In the latter, b ile pigments were seen on the luminal surface. In the two other TIPS w ithout tract occlusion, examined on days 49 and 293, a layer of endoth elial cells, proliferation of smooth muscle cells, and deposition of a n extracellular matrix such as collagen were confirmed, In the tract e xamined on day 293, there was protrusion of hepatocytes into the lumen through the stent wires. Conclusion: Short- and midterm TIPS occlusio ns were caused by thrombus forming after necrosis of hepatocytes and b ile leakage, respectively. Long-term TIPS stenosis was associated with a combination of pseudointimal hyperplasia and ingrowth of hepatocyte s.