Transjugular intrahepatic portosystemic shunt combined with viral suppression reverses decompensated cirrhosis: Two case reports

Figure 1 Patient follow-up and evaluation timeline. Patient 1: Underwent transjugular intrahepatic portosystemic shunt (TIPS) placement combined with antiviral therapy in April 2012, followed by regular follow-up and imaging surveillance. In June 2025, imaging revealed stent occlusion, prompting angiography with portal pressure gradient (PPG) measurement and liver biopsy. Patient 2: Underwent TIPS placement in July 2015 and required TIPS revision in December 2015 due to recurrent bleeding. The patient then continued regular follow-up and imaging surveillance. In July 2025, imaging demonstrated stent occlusion, leading to angiography with portal pressure gradient measurement and liver biopsy.

Figure 2 Imaging and histopathology illustrate portal pressure changes and hepatic fibrosis regression after transjugular intrahepatic portosystemic shunt. A: Baseline contrast-enhanced computed tomography showing cirrhosis with a small-volume ascites (yellow arrow) and esophagogastric varices (blue arrow); B: Final follow-up computed tomography demonstrating resolution of ascites and varices despite occlusion of the transjugular intrahepatic portosystemic shunt (TIPS) stent; C: Direct portography performed 6 months after TIPS for recurrent gastrointestinal bleeding showing stent occlusion with recurrent varices; portal pressure gradient was 25 mmHg, and TIPS revision was performed; D: Direct portography 10 years after TIPS showing stent occlusion without varices; portal pressure gradient was 6 mmHg, and no intervention was undertaken; E: Hematoxylin and eosin-stained liver tissue shows hepatocytes arranged in cords with preserved sinusoidal architecture. Interlobular septa are maintained with residual fibrous septa; there are no histologic features of cirrhosis or chronic inflammation; F: Masson’s trichrome staining reveals branched fibrous septa with expansion of portal fibrous tissue, without definite nodular remodeling or classic cirrhotic features. The fibrosis stage is Ishak 3.