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Jackson E, Markovic LE, Perlini M. Comparison of two-dimensional imaging to three-dimensional modeling of intrahepatic portosystemic shunts using computed tomography angiography. Vet Radiol Ultrasound 2024; 65:130-137. [PMID: 38279771 DOI: 10.1111/vru.13337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 01/28/2024] Open
Abstract
Computed tomography angiography (CTA) is used for the diagnosis of intrahepatic portosystemic shunts (IHPSS). When planning for transcatheter intervention, caudal vena cava (CVC) measurements are typically obtained from two-dimensional (2D) imaging to aid in stent selection. We hypothesized that clinically applicable three-dimensional (3D) IHPSS models can be generated, and CVC measurements will not differ between 2D images and 3D models. Computed tomography angiography datasets from client-owned dogs with IHPSS at the University of Georgia Veterinary Teaching Hospital from 2016 to 2022 were analyzed. Materialise Mimics 25.0 and 3-matic 17.0 were used for 3D modeling. Caudal vena cava diameters were measured in 2D dorsal and transverse planes 20 mm cranial and caudal from the shunt ostium and were compared with CVC diameters from 3D models. Length was measured in the 2D dorsal plane between midpoints of each diameter and compared to the 3D model length. Data are presented as mean (SD), and intraclass correlation coefficients were performed. Three-dimensional models were generated for 32 IHPSS (15 right-, 12 left-, and five central-divisional). Two-dimensional dorsal and transverse area-associated diameter measurements were 16.7 mm (5.6) and 15.5 mm (4.2) cranial; 14.9 mm (4.2) and 14.3 mm (3.7) caudal. Three-dimensional area-associated diameter measurements were 15.3 mm (4.4) cranial and 14.0 mm (3.6) caudal. The 2D length was 61.5 mm (7.1) compared with 3D 59.9 mm (7.2). Intraclass correlation coefficients comparing 2D and 3D diameters were all >0.80, indicating very good agreement, with good agreement (>0.60) for length. Clinically applicable 3D IHPSS models can be generated using engineering software. Measurements from 3D models are consistent with 2D planar imaging. Both 2D CTA and 3D virtual models can be utilized for preprocedural planning, depending on clinician preference.
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Affiliation(s)
- Erin Jackson
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Lauren E Markovic
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Michael Perlini
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
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Spies K, Ogden J, Sterman A, Davidson J, Scharf V, Reyes B, Luther JK, Martin L, Kudej R, Stockman T, Gallaher HMJ, Buote NJ, Smith M, Ciepluch B, Amore R, Sherman AH, Wallace ML. Clinical presentation and short-term outcomes of dogs ≥15 kg with extrahepatic portosystemic shunts. Vet Surg 2024; 53:277-286. [PMID: 37846027 DOI: 10.1111/vsu.14040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE To describe demographics, clinical presentation, shunt anatomy, clinical progression, and complications in large dogs ≥15 kg with single extrahepatic portosystemic shunts (EHPSS) treated with or without surgery. STUDY DESIGN Multicenter retrospective (10 university hospitals, one private referral institution). ANIMALS Dogs ≥15 kg (n = 63). METHODS Medical records of dogs ≥15 kg diagnosed with EHPSS between January 01, 2005 and December 31, 2020 were reviewed. Dogs had a minimum follow-up of 90 days. Signalment, clinical signs, diagnostics, shunt anatomy, treatment interventions, and perioperative complications were assessed. RESULTS Median age was 21.9 months (IQR: 9-36.8). The breed most represented was the Golden retriever (17/63 dogs). Portocaval (17/63) and splenocaval (15/63) shunt configurations were most common. Portal vein hypoplasia was noted in 18 imaging reports. Of the surgically treated dogs, 14/45 (35.6%) had short-term complications, and 3/45 (6.7%) had shunt-related deaths. Medical management was discontinued in 15/40 and reduced in 9/40 of surviving dogs who had surgical attenuation. All medically managed, nonattenuated dogs (18/18) were maintained on their original shunt-related medication regimens. CONCLUSIONS Clinical presentation of dogs ≥15 kg with extrahepatic portosystemic shunts was similar to the more commonly reported small breed dogs. Surgical management of single EHPSS in large dogs ≥15 kg had similar clinical short-term outcomes as small breed dogs. CLINICAL SIGNIFICANCE Clinicians should be aware that large breed dogs with EHPSS share similar characteristics and clinical outcomes to small breed dogs. The significance of the presence of a hypoplastic portal vein warrants further research. Surgical treatment is a viable option for large breed dogs with EHPSS.
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Affiliation(s)
- Kate Spies
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Jessica Ogden
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Allyson Sterman
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Jackie Davidson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Valery Scharf
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Bianca Reyes
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Jill Kristine Luther
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Libby Martin
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Raymond Kudej
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Tiffany Stockman
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Hayley Maloof-Jones Gallaher
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Nicole J Buote
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Meghan Smith
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Brittany Ciepluch
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Riley Amore
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Alec H Sherman
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Mandy L Wallace
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
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Kawamura Y, Itou H, Kida A, Sunakawa H, Suzuki M, Kawamura K. Percutaneous shunt vessel embolisation with Amplatzer vascular plugs II and IV in the treatment of dogs with splenophrenic shunts: four cases (2019-2022). J Small Anim Pract 2023; 64:710-717. [PMID: 37817531 DOI: 10.1111/jsap.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 04/23/2023] [Accepted: 06/10/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES To describe the treatment of four dogs with splenophrenic shunts using percutaneous shunting vessel embolisation with Amplatzer vascular plugs II and IV and provide information on their clinical outcomes. MATERIALS AND METHODS Dogs with splenophrenic shunts treated at a veterinary hospital from January 2019 to December 2022 were identified through a medical record search. RESULTS Six dogs with splenophrenic shunts were identified. Two dogs were excluded because they were treated with laparoscopic surgery. Four underwent percutaneous shunting vessel embolization with Amplatzer vascular plugs and were included in the case series. A sheath was placed in the left external jugular vein and a balloon catheter was advanced to the shunting vessel under fluoroscopy. Portal vein pressure was confirmed to be within an acceptable range during temporary balloon occlusion. Based on preoperative CT angiography and intraoperative contrast examination, Amplatzer vascular plugs II were selected for two dogs and IV were selected for two dogs. Under fluoroscopy, the plug was deployed into the shunting vessel, and angiography confirmed occlusion. In all cases, the increase in portal pressure after temporary occlusion was within the acceptable range, and complete occlusion of blood flow was possible with a single plug. There were no major procedure-related complications. No dogs developed post-ligation seizures or signs of portal hypertension. In addition, improvements in ammonia values were observed in all cases. CLINICAL SIGNIFICANCE Percutaneous splenophrenic shunt embolisation using Amplatzer vascular plugs II and IV is technically feasible in dogs, and assessed by intra-procedure angiography, a single plug completely obstructed blood flow in all dogs. Based on the literature search, this is the first report describing Amplatzer vascular plugs for the treatment of splenophrenic shunts.
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Affiliation(s)
- Y Kawamura
- Kawamura Animal Hospital, 1-1-6 Kamikido, Higashi-ku, Niigata City, Niigata, 950-0891, Japan
| | - H Itou
- Kawamura Animal Hospital, 1-1-6 Kamikido, Higashi-ku, Niigata City, Niigata, 950-0891, Japan
| | - A Kida
- Kawamura Animal Hospital, 1-1-6 Kamikido, Higashi-ku, Niigata City, Niigata, 950-0891, Japan
| | - H Sunakawa
- Kawamura Animal Hospital, 1-1-6 Kamikido, Higashi-ku, Niigata City, Niigata, 950-0891, Japan
| | - M Suzuki
- Kawamura Animal Hospital, 1-1-6 Kamikido, Higashi-ku, Niigata City, Niigata, 950-0891, Japan
| | - K Kawamura
- Kawamura Animal Hospital, 1-1-6 Kamikido, Higashi-ku, Niigata City, Niigata, 950-0891, Japan
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Ishigaki K, Asano K, Tamura K, Sakurai N, Terai K, Heishima T, Yoshida O. Percutaneous transvenous coil embolization (PTCE) for treatment of single extrahepatic portosystemic shunt in dogs. BMC Vet Res 2023; 19:215. [PMID: 37858152 PMCID: PMC10585740 DOI: 10.1186/s12917-023-03783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND There is limited information regarding percutaneous transvenous coil embolization (PTCE) for single extrahepatic portosystemic shunt (PSS). This study aimed to describe the procedure and outcome of PTCE in dogs with a single extrahepatic PSS. Forty-two privately owned dogs were included in this study. All dogs were diagnosed with extrahepatic PSS by computed tomography (CT). Preoperative CT images were used to evaluate the diameter of the PSS for coil placement. A multipurpose balloon catheter was percutaneously inserted into the PSS via the jugular vein, and transvenous retrograde portography (TRP) and measurement of blood pressure in the PSS (pPSS) were performed during balloon inflation; one or more embolization coils were implanted via the catheter. RESULTS In most cases, preoperative median fasting and postprandial serum total bile acid (TBA) concentrations were high (fasting, 86.5 μmol/L [ 3.7-250.0 μmol/L]; postprandial, 165.5 μmol/L [ 1.5-565.0 μmol/L]). CT revealed that 30 dogs had left gastrophrenic shunt; eight had left gastroazygos shunt; and one each had left gastrocaval, splenocaval, splenophrenic, and left colocaval shunt. TRP revealed that intrahepatic portal vascularity was clearly detectable in all dogs. The median values of pPSS before and during the balloon occlusion were 4.8 mmHg [2.0-13.0 mmHg] and 8.6 mmHg [5.0-18.0 mmHg], respectively. The median number and diameter of coils used were 2 coils [1 - 5 coils] and 8.0 mm [4.0 - 12.0 mm], respectively. The median times of irradiation and PTCE were 9 min [4-26 min] and 40 min [23-75 min], respectively. The median fasting and postprandial TBAs significantly decreased to 8.2 μmol/L [0.3-45.1 μmol/L, n = 38, p = 0.0028] and 19.8 μmol/L [0.3-106.7 μmol/L, n = 38, p = 0.0018], respectively, approximately 1 month after PTCE. The clinical success rate of PTCE without requirement for a second surgery was 95.2% (40/42 dogs). During revision surgery, one dog underwent surgical ligation and, in another dog, an ameroid constrictor was placed. CONCLUSIONS PTCE was clinically effective in treating single extrahepatic PSS in dogs. Preoperative CT and TRP prior to PTCE might be clinically valuable for choosing the size of embolization coils, deciding the appropriate location of coil implantation, and estimating the number of coils to be implanted. PTCE is a promising alternative to conventional surgical procedures for single extrahepatic PSS in dogs.
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Affiliation(s)
- Kumiko Ishigaki
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Kazushi Asano
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan.
| | - Kei Tamura
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Naoki Sakurai
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Kazuyuki Terai
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Tatsuya Heishima
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Orie Yoshida
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
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Konstantinidis AO, Adamama-Moraitou KK, Patsikas MN, Papazoglou LG. Congenital Portosystemic Shunts in Dogs and Cats: Treatment, Complications and Prognosis. Vet Sci 2023; 10:vetsci10050346. [PMID: 37235429 DOI: 10.3390/vetsci10050346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Congenital portosystemic shunts (CPSS) are a common vascular anomaly of the liver in dogs and cats. Clinical signs of CPSS are non-specific and may wax and wane, while laboratory findings can raise the clinical suspicion for CPSS, but they are also not specific. Definitive diagnosis will be established by evaluation of liver function tests and diagnostic imaging. The aim of this article is to review the management, both medical and surgical, complications, and prognosis of CPSS in dogs and cats. Attenuation of the CPSS is the treatment of choice and may be performed by open surgical intervention using ameroid ring constrictors, thin film banding, and partial or complete suture ligation or by percutaneous transvenous coil embolization. There is no strong evidence to recommend one surgical technique over another. Medical treatment strategies include administration of non-absorbable disaccharides (i.e., lactulose), antibiotics, and dietary changes, and are indicated for pre-surgical stabilization or when surgical intervention is not feasible. After CPSS attenuation, short- and long-term post-surgical complications may be seen, such as post-operative seizures and recurrence of clinical signs, respectively. Prognosis after surgical attenuation of CPSS is generally favorable for dogs and fair for cats.
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Affiliation(s)
- Alexandros O Konstantinidis
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Katerina K Adamama-Moraitou
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Michail N Patsikas
- Laboratory of Diagnostic Imaging, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Lysimachos G Papazoglou
- Companion Animal Clinic (Surgery and Obstetrics Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
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Economu L, Strickland R, Lipscomb VJ. Surgical treatment and outcome of intrahepatic shunts in 12 cats. J Feline Med Surg 2022; 24:e411-e419. [PMID: 35833502 PMCID: PMC10812295 DOI: 10.1177/1098612x221109325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CASE SERIES SUMMARY The objective of this case series was to describe the presentation, surgical treatment and outcome of a congenital intrahepatic portosystemic shunt (IHPSS) in 12 cats. A retrospective case series of cats undergoing surgical treatment for an IHPSS was undertaken. Signalment, clinical signs, imaging, surgical treatment, complications and short-term outcome (<30 days) were obtained using medical records. Long-term outcome (>1 year after first surgery) was obtained, where possible, using a health-related quality of life owner questionnaire. Seven cats were diagnosed with a left divisional shunt, three with a central divisional shunt and two with a right divisional shunt using intraoperative mesenteric portovenography. Three cats tolerated complete acute suture attenuation, eight cats underwent partial suture attenuation, four of which received complete suture ligation at a second surgery, and one cat underwent partial attenuation with a thin film band. Six cats (50%) developed post-attenuation neurological signs (PANS) after first surgery and two cats (17%) died or were euthanased due to severe PANS. Long-term outcome was available for eight cats (67%), with a median follow-up time of 1743 days (range 364-2228), and was described as excellent in five cats (63%), fair in two cats (25%) and poor in one cat (12%). RELEVANCE AND NOVEL INFORMATION Few papers exist that describe the presentation, intraoperative imaging, treatment and outcome of IHPSSs in cats. This is the first to describe surgical attenuation with a thin film band in a cat with an IHPSS. This case series reports excellent long-term outcomes in a majority of surgically treated cats with IHPSS.
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Affiliation(s)
- Lavinia Economu
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, Hatfield, UK
| | - Rhiannon Strickland
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, Hatfield, UK
| | - Vicky J Lipscomb
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, Hatfield, UK
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Poggi E, Rubio DG, Pérez Duarte FJ, Del Sol JG, Borghetti L, Izzo F, Cinti F. Laparoscopic portosystemic shunt attenuation in 20 dogs (2018-2021). Vet Surg 2022; 51 Suppl 1:O138-O149. [PMID: 35194798 DOI: 10.1111/vsu.13785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To describe the technique, complications, and outcome of laparoscopic portosystemic shunt attenuation (LPSSA) in dogs. STUDY DESIGN Retrospective study. ANIMALS Twenty client-owned dogs. METHODS Medical records were searched for dogs with a single congenital extrahepatic portosystemic shunt (CEPSS) that was treated with LPSSA. Signalment, clinical signs, CEPSS location, diagnostic imaging, laparoscopic approach, operative technique, complications, and clinical outcome were reviewed. RESULTS Fourteen dogs with CEPSS located in the epiploic foramen had a right (13/14) or left (1/14) paramedian approach. In 6 dogs a CEPSS was not located in the epiploic foramen, and a left paramedian approach was used. A 3 or 4-port technique was used in 7 and 13 dogs, respectively. A thin film band was used for CEPSS attenuation in all dogs. The median operating time for LPSSA was 62 min (range 27-98 min). Intraoperative complications requiring conversion to an open technique occurred in 5 dogs. Mild perioperative self-limiting portal hypertension occurred in 3 dogs, while severe portal hypertension with surgical revision occurred in 1 case. The complications were resolved, and all dogs had a good outcome. CONCLUSION Laparoscopic portosystemic shunt attenuation can be performed in dogs, in particular for a CEPSS located in the epiploic foramen using a right paramedian approach. For CEPSS not located in the epiploic foramen, a left paramedian approach is recommended. Conversion to open celiotomy was required in around a third of cases. CLINICAL SIGNIFICANCE Laparoscopic attenuation of CEPSSs can be performed in dogs and has a good clinical outcome, particularly for CEPSS located in the epiploic foramen.
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Affiliation(s)
| | | | | | | | | | | | - Filippo Cinti
- Clinica Veterinaria Apuana AniCura, Carrara, Italy.,Ospedale Veterinario I Portoni Rossi, Zola Predosa, Italy
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Wallace ML. Updates in Hepatobiliary Surgery. Vet Clin North Am Small Anim Pract 2022; 52:369-385. [DOI: 10.1016/j.cvsm.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Culp WTN, Griffin MA, Case JB, Zwingenberger AL, Marks SL. Use of percutaneous transvenous coil embolization in the treatment of intrahepatic portosystemic shunts in four cats. J Am Vet Med Assoc 2021; 257:70-79. [PMID: 32538708 DOI: 10.2460/javma.257.1.70] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 4 cats (6 to 9 months old) were evaluated because of clinical signs consistent with a portosystemic shunt (PSS). CLINICAL FINDINGS Among the 4 cats, 3 had neurologic abnormalities including ataxia, head pressing, disorientation, and obtundation. One cat was evaluated because of urethral obstruction; a retrieved urethral stone was determined to have urate composition. Clinicopathologic findings (hypoproteinemia, low BUN concentration, and high serum bile acids concentration) were consistent with a PSS in all cats. A diagnosis of intrahepatic PSS (IHPSS) was made for all cats on the basis of ultrasonographic and CT findings. TREATMENT AND OUTCOME All cats underwent percutaneous transvenous coil embolization (PTCE). No major intraprocedural complications were encountered, and all cats were discharged from the hospital. For the 3 cats that were presented with neurologic signs, an evaluation performed at 12, 14, or 48 months after the procedure revealed resolution of the neurologic signs, and owners reported that the behavior of each cat appeared normal. One cat that initially had neurologic and gastrointestinal signs had lower urinary tract signs after PTCE and developed an acquired extrahepatic PSS. CLINICAL RELEVANCE Although IHPSSs in cats are uncommon, the outcomes of PTCE for the 4 cats of the present report suggested that this treatment may benefit cats with an IHPSS. No short-term complications were encountered, and all cats had improvement in clinical signs following PTCE, although an acquired extrahepatic PSS was later identified in 1 cat. Further investigation of the use of endovascular techniques for the treatment of IHPSSs in cats and other species is warranted.
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Culp WTN, Griffin MA. Interventional Radiology Management of Vascular Malformations: Portosystemic Shunts and Vascular Fistulae/Malformations. Vet Clin North Am Small Anim Pract 2018; 48:781-795. [PMID: 29933944 DOI: 10.1016/j.cvsm.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Vascular malformations are abnormal connections between blood vessels that can have various endothelial characteristics. Although uncommon, these malformations can present challenging diagnostic and therapeutic scenarios. The use of interventional radiology techniques in the management of various vascular malformations is an attractive option because of the ability to treat these malformations at the most appropriate anatomic location and in the most effective manner. Techniques such as coil embolization of intrahepatic portosystemic shunts and liquid embolization of arteriovenous fistulae/malformations have shown tremendous potential as treatments for these challenging diseases.
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Affiliation(s)
- William T N Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - Maureen A Griffin
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA
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11
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Culp WTN, Zwingenberger AL, Giuffrida MA, Wisner ER, Hunt GB, Steffey MA, Mayhew PD, Marks SL. Prospective evaluation of outcome of dogs with intrahepatic portosystemic shunts treated via percutaneous transvenous coil embolization. Vet Surg 2017; 47:74-85. [PMID: 29064581 DOI: 10.1111/vsu.12732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 05/04/2017] [Accepted: 06/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report outcome and complications after percutaneous transvenous coil embolization (PTCE) and evaluate the clinical, laboratory, and imaging changes in dogs with intrahepatic portosystemic shunts (IHPSS) pre-PTCE and post-PTCE. STUDY DESIGN Prospective clinical trial. ANIMALS Twenty-five dogs (15 dogs in imaging subgroup) with IHPSS. METHODS Clinical signs, hematologic, and biochemical parameters were recorded before and 3 months after PTCE. All dogs received the same medical treatment and underwent PTCE. In the imaging subgroup, ultrasonography, hepatic portal scintigraphy, and computed tomography-angiography were performed pre-PTCE and post-PTCE. RESULTS All evaluated bloodwork values improved by at least 50% of their initial value, by 3 months post-PTCE. Liver volume increased after PTCE (P = .001), but remained lower than normal in 11/15 dogs. Hepatic arterial fraction decreased after PTCE (P = .029), consistent with increased portal blood flow to the liver. Twenty-four of 25 dogs were available for reevaluation at 3 months, and all abnormal clinical signs had resolved in 22/24 dogs. CONCLUSION PTCE appears promising as a treatment for IHPSS, as clinical signs resolved in most cases, bloodwork abnormalities often normalized, and the procedure was performed safely with minimal complications. PTCE increased hepatic portal perfusion and liver volume in most dogs. These promising results justify a future randomized clinical trial comparing PTCE, other attenuation options, and medical management alone.
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Affiliation(s)
- William T N Culp
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Allison L Zwingenberger
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Michelle A Giuffrida
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Erik R Wisner
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Geraldine B Hunt
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Michele A Steffey
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Stanley L Marks
- Department of Medicine and Epidemiology, University of California-Davis, School of Veterinary Medicine, Davis, California
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Tivers MS, Lipscomb VJ, Brockman DJ. Treatment of intrahepatic congenital portosystemic shunts in dogs: a systematic review. J Small Anim Pract 2017; 58:485-494. [DOI: 10.1111/jsap.12712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/15/2017] [Accepted: 05/23/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M. S. Tivers
- School of Veterinary Sciences; University of Bristol; Bristol BS40 5DU UK
| | - V. J. Lipscomb
- Department of Clinical Sciences and Services; Royal Veterinary College; Hertfordshire AL9 7TA UK
| | - D. J. Brockman
- Department of Clinical Sciences and Services; Royal Veterinary College; Hertfordshire AL9 7TA UK
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Cook DA, Gavaghan BJ, Moses PA. Balloon occlusion of the caudal vena cava for vascular contrast studies as an aid to intravascular coil embolisation for the treatment of intrahepatic portosystemic shunts in three dogs. Aust Vet J 2016; 93:452-9. [PMID: 26769071 DOI: 10.1111/avj.12383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 07/08/2014] [Accepted: 09/15/2015] [Indexed: 11/30/2022]
Abstract
CASE REPORT Three dogs were treated with fluoroscopically guided coil embolisation of intrahepatic portosystemic shunts. A large-diameter vascular occlusion balloon was used to improve the vascular contrast studies required to perform this procedure. This technique improved identification of vascular structures and allowed completion of the procedures without the need for digital subtraction angiography. CLINICAL SIGNIFICANCE Interventional radiological procedures are an emerging area of veterinary medicine and procedural modifications may help expand their use in clinical practice.
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Affiliation(s)
- D A Cook
- Veterinary Specialist Services, Shop 14, Hometown, Cnr Logan and Lexington Roads, Underwood, Queensland, 4119, Australia.
| | - B J Gavaghan
- Veterinary Cardiology and Imaging P/L, Dayboro, QLD, Australia
| | - P A Moses
- Veterinary Specialist Services, Shop 14, Hometown, Cnr Logan and Lexington Roads, Underwood, Queensland, 4119, Australia
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14
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Woodford NS, Hotson Moore A, Renfrew H, Tulloch L, Casey M. Surgical management of an extrahepatic portosystemic shunt in a foal: A multidisciplinary problem. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - A. Hotson Moore
- Bath Referrals; Rosemary Lodge Veterinary Hospital; Wellsway UK
| | - H. Renfrew
- VetCT Specialists; St Johns Innovation Centre; Cambridge UK
| | | | - M. Casey
- Faculty of Veterinary Medicine; University of Glasgow; UK
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15
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Knapp T, Navalòn I, Medda M, Pradelli D, Borgonovo S, Crosta C, Bussadori CM. A multimodality imaging approach for guiding a modified endovascular coil embolization of a single intrahepatic portosystemic shunt in dogs. Res Vet Sci 2015; 103:156-63. [PMID: 26679811 DOI: 10.1016/j.rvsc.2015.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 09/25/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Abstract
Intrahepatic portosystemic shunts (IHPSS) in dogs are aberrant vascular anomalies that connect the portal and the systemic venous vessels. In most of the patients, the surgical approach is unfavourable due to the difficulties in isolating the IHPSS, making the option of a percutaneous transvenous coil embolization (PTCE) one of the safer occlusive procedures. This study describes the treatment of eight dogs with a single IHPSS using a multimodality imaging approach to guide the modified PTCE procedure. This new technique results in a decrease of 71% of the time of the entire procedure with the reduction of 91% in the time required involved the IHPSS identification and in the fluoroscopy exposure time avoiding the need for iodinated contrast agents during the procedure. Moreover, the placement of the catheter before the caval stent ensures its greater stability, enhancing the procedural safety in the phase when the coils are released and avoiding the risk of their dislocation.
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Affiliation(s)
- Teja Knapp
- Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131 Milan, Italy.
| | | | | | - Danitza Pradelli
- Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131 Milan, Italy.
| | - Simone Borgonovo
- Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131 Milan, Italy.
| | - Cristina Crosta
- Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131 Milan, Italy.
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Thieman Mankin KM. Current Concepts in Congenital Portosystemic Shunts. Vet Clin North Am Small Anim Pract 2015; 45:477-87. [DOI: 10.1016/j.cvsm.2015.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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17
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Culp WTN, Glaiberman CB, Pollard RE, Wisner ER. Use of ethylene-vinyl alcohol copolymer as a liquid embolic agent to treat a peripheral arteriovenous malformation in a dog. J Am Vet Med Assoc 2015; 245:216-21. [PMID: 24984133 DOI: 10.2460/javma.245.2.216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION An 11-year-old castrated male Tibetan Mastiff was evaluated because of a visibly enlarged blood vessel and progressively worsening swelling of the right hind limb. CLINICAL FINDINGS On physical examination, the right hind limb was markedly larger than the left hind limb and the dog was minimally weight bearing on the affected limb. A bruit was auscultated over the affected region. Ultrasonography of the tarsal region of the right hind limb revealed an artery with turbulent flow that communicated with venous drainage. A CT scan confirmed the presence of an arteriovenous malformation (AVM). TREATMENT AND OUTCOME Embolization of the AVM with a liquid embolic agent (ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide) was elected. An arteriogram was performed prior to treatment and delineated the vessels that were targeted for embolization. The embolic agent was infused into the AVM, and a postinjection arteriogram confirmed complete occlusion of the AVM nidus and normal arterial flow to the paw with subsequent normal venous drainage. The circumference of the abnormal paw was 51 cm before the procedure and 22.9 cm at 4 weeks after the procedure. Additionally, the gait of the dog dramatically improved. No complications associated with the procedure developed. CLINICAL RELEVANCE Peripheral AVMs in dogs are uncommon, and described treatment options are limited and generally associated with serious morbidity. A liquid embolic agent, ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide, was successfully administered in this case, and no morbidity was observed secondary to the procedure. Clinical success was characterized by substantial improvement in limb swelling and marked improvement in the gait of the dog.
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Affiliation(s)
- William T N Culp
- Departments of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616
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18
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Weisse C, Berent AC, Todd K, Solomon JA, Cope C. Endovascular evaluation and treatment of intrahepatic portosystemic shunts in dogs: 100 cases (2001-2011). J Am Vet Med Assoc 2014; 244:78-94. [PMID: 24344856 DOI: 10.2460/javma.244.1.78] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate short- and long-term outcome following endovascular treatment of intrahepatic portosystemic shunts in dogs. DESIGN Retrospective case series. ANIMALS 100 dogs. PROCEDURES All patients had angiographic evaluation with or without endovascular shunt attenuation. The medical records were reviewed for pertinent data, complications, outcome, and survival time. RESULTS 95 dogs with congenital intrahepatic portosystemic shunts received 111 procedures (83% [79/95] had 1 treatment, and 17% [16/95] had > 1 treatment; 5 dogs had no treatment because of excessive portal venous pressure-central venous pressure gradients). Angiography identified 38 right, 33 left, and 19 central divisional single shunts (n = 90) and 10 complex or multiple shunts. Partial shunt attenuation was performed in 92 dogs by means of caval stent placement and insertion of thrombogenic coils within the shunt, and 3 had complete acute shunt occlusion. Major intraoperative complications (3/111 [3%]) included temporary severe portal hypertension in 2 dogs and gastrointestinal hemorrhage in 1 dog. Major postoperative (< 1 week after surgery) complications (14/111 [13%]) included seizures or hepatoencephalopathy (7/111 [6%]), cardiac arrest (2/111 [2%]), jugular site bleeding (2/111 [2%]), pneumonia (1/111 [1%]), suspected portal hypertension (1/111 [1%]), and acute death (1/111 [1%]). Median follow-up time was 958 days (range, 0 to 3,411 days). Median survival time for treated dogs was 2,204 days (range, 0 to 3,411 days). Outcome was considered excellent (57/86 [66%]) or fair (13/86 [15%]) in 70 of 86 (81%) treated dogs. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that endovascular treatment of intrahepatic shunts in dogs may result in lower morbidity and mortality rates, with similar success rates, compared with previously reported outcomes for open surgical procedures. Gastrointestinal ulceration was a common finding among this population of dogs, and lifelong gastroprotectant medications are now recommended.
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Affiliation(s)
- Chick Weisse
- Department of Diagnostic Imaging and Interventional Radiology, The Animal Medical Center, 510 E 62nd St, New York, NY 10065
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Saito M, Seo Y, Yano Y, Momose K, Hirano H, Yoshida M, Azuma T. Successful treatment using coil embolization of a symptomatic intrahepatic portosystemic venous shunt developing through a patent ductus venosus in a noncirrhotic adult. Intern Med 2013; 52:555-9. [PMID: 23448764 DOI: 10.2169/internalmedicine.52.9110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The patient was a 60-year-old man with encephalopathy without liver cirrhosis. CT angiography revealed a patent ductus venosus between the anterior segmental branch of the portal vein and the middle hepatic vein. Coils were framed in the patent ductus venosus and then used to fill in the frame. After treatment, transarterial portography showed that the shunt flow of the ductus venosus had decreased significantly. After one day, the patient's disturbance of consciousness disappeared. Our case involved the adult-onset of a patent ductus venosus, which is extremely rare. This case is the first in which coil embolization was successfully achieved in a noncirrhotic elderly patient with a patent ductus venosus.
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Affiliation(s)
- Masaya Saito
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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20
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Nanfelt MR, Marolf AJ, Powers BE, Monnet E. Use of a Dacron shape-memory intravascular coil to achieve slow, progressive occlusion of the jugular vein in dogs. Vet Surg 2012; 40:853-60. [PMID: 22380668 DOI: 10.1111/j.1532-950x.2011.00872.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the ability of shape memory Dacron polymer vascular coils to induce the complete, gradual occlusion of the canine jugular vein. STUDY DESIGN Observational pilot study. ANIMALS Nine purpose-bred dogs. METHODS Eighteen coils were deployed in nine dogs using fluoroscopic-guided percutaneous transvenous coil implantation. Individual coil formulations varied around a Dacron polymer base. Jugular vein diameter, percent vessel occlusion, and thrombus echogenicity were monitored at weekly intervals using ultrasonography. Affected jugular veins were harvested at 6 weeks post-implantation and histopathological analysis was performed to assess adventitial fibrosis, intimal layer thickening, and inflammation. RESULTS Ten coils migrated from the jugular veins to the pulmonary vasculature within 0-2 weeks following implantation. Three jugular veins achieved at least 90% occlusion at six weeks. Histopathology of these jugular veins revealed marked perivascular thickening and fibrovascular proliferation, increased infiltration of macrophages, neutrophils and lymphocytes, and abundant fibroplasia. CONCLUSIONS Complete, gradual occlusion of a jugular vein was achieved in three dogs. Significant vessel wall reaction and inflammation can induce gradual vessel occlusion when a Dacron coil remains implanted within the jugular vein. Dacron polymer coils could be a feasible treatment option for the gradual occlusion of congenital portosystemic shunts in dogs using minimally invasive, percutaneous transvenous implantation.
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Affiliation(s)
- Michelle R Nanfelt
- James L. Voss Veterinary Medical Center and the Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA
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Hug S, Guerrero T, Makara M, Kummer M, Grest P, Bettschart R, Schwarzwald C. Diagnosis and Surgical Cellophane Banding of an Intrahepatic Congenital Portosystemic Shunt in a Foal. J Vet Intern Med 2011; 26:171-7. [DOI: 10.1111/j.1939-1676.2011.00837.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 09/13/2011] [Accepted: 10/10/2011] [Indexed: 11/26/2022] Open
Affiliation(s)
| | | | | | | | - P. Grest
- Institute of Veterinary Pathology; Vetsuisse Faculty; University of Zurich; Zurich; Switzerland
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Tivers MS, Upjohn MM, House AK, Brockman DJ, Lipscomb VJ. Treatment of extrahepatic congenital portosystemic shunts in dogs - what is the evidence base? J Small Anim Pract 2011; 53:3-11. [PMID: 22098116 DOI: 10.1111/j.1748-5827.2011.01144.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A variety of surgical treatments and medical therapies are recommended for dogs with extrahepatic congenital portosystemic shunts (CPSS). The objective of this review was to assess the evidence base for the management of extrahepatic CPSS in dogs. An online bibliographic search was performed in November 2010 to identify articles relating to the question "Which of the treatment options for extrahepatic CPSS in dogs offers the best short- and long-term outcomes?" Articles were assigned a level of evidence based on a modified grading system. Thirty-eight articles were included in the review. Thirty-six articles were classified as grade 4 and two as grade 5. The timings and methods of assessment of short- and long-term outcomes varied widely between studies. One prospective study (grade 4a) showed that surgically treated dogs survived significantly longer than medically treated dogs. Four retrospective studies (grade 4b) compared the outcome of two surgical techniques but there were no statistically significant differences between treatment groups in terms of complications or outcome. The review found that the evidence base for the treatment of extrahepatic CPSS is weak. There is a lack of evidence of short- and long-term outcomes to recommend one treatment over another.
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Affiliation(s)
- M S Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, United Kingdom
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Dunn ME. Thrombectomy and thrombolysis: the interventional radiology approach. J Vet Emerg Crit Care (San Antonio) 2011; 21:144-50. [DOI: 10.1111/j.1476-4431.2011.00627.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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MAI WILFRIED, WEISSE CHICK. CONTRAST-ENHANCED PORTAL MAGNETIC RESONANCE ANGIOGRAPHY IN DOGS WITH SUSPECTED CONGENITAL PORTAL VASCULAR ANOMALIES. Vet Radiol Ultrasound 2010; 52:284-8. [DOI: 10.1111/j.1740-8261.2010.01771.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Hogan DF, Benitez ME, Parnell NK, Green HW, Sederquist K. Intravascular occlusion for the correction of extrahepatic portosystemic shunts in dogs. J Vet Intern Med 2010; 24:1048-54. [PMID: 20695990 DOI: 10.1111/j.1939-1676.2010.0565.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Congential extrahepatic portosystemic shunts (EHPSS) are common in dogs. An effective minimally invasive technique for correction of EHPSS could result in reduced morbidity, reduced costs, and reduced hospitalization times. HYPOTHESIS Use of an intravascular occlusion device can effectively and safely result in acute complete occlusion of EHPSS in dogs. ANIMALS Seven dogs with naturally occurring EHPSS that presented to the Purdue University Veterinary Teaching Hospital. METHODS Prospective, clinical trial. The 7 dogs were consecutively enrolled over a 2-year period. Results of serum biochemistry, total serum bile acids, fasting plasma ammonia, abdominal radiography, and ultrasonography suggested the diagnosis of portosystemic shunts in all dogs. Definitive diagnosis of EHPSS was achieved with cranial mesenteric arterial portography and acute occlusion was attempted by the deployment of the Amplatzer vascular plug (AVP). RESULTS EHPSS were identified in all dogs consisting of 5 portocaval and 2 portoazygous variants; 1/7 dogs (14%) were intolerant to temporary complete occlusion of the EHPSS. Of the remaining 6 dogs, 5 (83%) had complete occlusion of the EHPSS by the AVP. There were no complications and resolution of abnormal clinical signs and laboratory values was achieved in 4/5 (80%) dogs with complete occlusion. CONCLUSIONS AND CLINICAL IMPORTANCE Intravascular correction of EHPSS by the AVP is a viable option to surgical correction while larger studies will be required to determine the clinical applicability of this procedure in the broader portosystemic shunt population.
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Affiliation(s)
- D F Hogan
- School of Veterinary Medicine, Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, IN, USA.
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SCHNEIDER MATTHIAS, PLASSMANN MADELEINE, RAUBER KLAUS. INTRAHEPATIC VENOUS COLLATERALS PREVENTING SUCCESSFUL STENT-SUPPORTED COIL EMBOLIZATION OF INTRAHEPATIC SHUNTS IN DOGS. Vet Radiol Ultrasound 2009; 50:376-84. [DOI: 10.1111/j.1740-8261.2009.01553.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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