Histopathologic study of stenotic and occluded transjugular intrahepatic portosystemic shunts.

PURPOSE: A detailed histopathologic analysis of three stenotic and two occluded transjugular intrahepatic portosystemic shunts was performed to evaluate the nature and cause of each shunt abnormality.

PATIENTS AND METHODS: The study group consists of five patients who developed a shunt stenosis or occlusion and subsequently underwent liver transplantation or autopsy. Shunt specimens were examined grossly and microscopically.

RESULTS: The pseudointima was composed of granulation tissue, which was generally denser and more cellular near the luminal surface. Pseudointima was thicker in the parenchymal portion of the shunt than at the venous ends. A contiguous single layer of endothelial-like cells lined the majority of the luminal surface of each shunt. Scattered debris and clot covered 10%-15% of the luminal surfaces. Transected bile ducts were noted in three cases. Bile staining was detected around the transected ducts, and bile pigment was incorporated into the developing pseudointima.

CONCLUSIONS: Pseudointimal hyperplasia appears to be the causative lesion in these obstructions. An inflammatory reaction incited by bile extravasation may have contributed to pseudointimal proliferation in three cases.