1
|
Visser J, Schoemaker NJ, van Zeeland YRA, Veraa S, Kik MJL, Fieten H, Kummeling A. Diagnosis and treatment of a congenital portosystemic shunt in a ferret (Mustela putorius furo). J Small Anim Pract 2024; 65:75-78. [PMID: 37560781 DOI: 10.1111/jsap.13659] [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: 06/26/2022] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 08/11/2023]
Abstract
A 3-year-old female neutered ferret presented with progressive weight loss was diagnosed with portosystemic shunting based on increased fasting bile acids, rectal ammonia tolerance testing and advanced imaging. Ammonia reference values were determined in 16 healthy ferrets. A congenital extrahepatic spleno-caval shunt was visualised with ultrasonography and CT angiography of the abdomen. Complete surgical shunt closure by suture ligation was performed, without clinical improvement after surgery. Euthanasia was elected 4 months postoperatively because the clinical condition deteriorated. This is a case report of advanced diagnostics and surgical treatment of a congenital extrahepatic portosystemic shunt in a ferret, demonstrating rectal ammonia tolerance testing and imaging as feasible techniques for the diagnosis.
Collapse
Affiliation(s)
- J Visser
- Animal Referral Centre, Auckland, New Zealand
| | - N J Schoemaker
- Department Clinical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Y R A van Zeeland
- Department Clinical Sciences, Utrecht University, Utrecht, The Netherlands
| | - S Veraa
- Department Clinical Sciences, Utrecht University, Utrecht, The Netherlands
| | - M J L Kik
- Department Biomolecular Health Sciences - Pathology Division, Utrecht University, Utrecht, The Netherlands
| | - H Fieten
- Department Clinical Sciences, Utrecht University, Utrecht, The Netherlands
| | - A Kummeling
- Department Clinical Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Serrano G, Devriendt N, de Rooster H. Repeated specific canine pancreatic lipase measurements do not identify multiple acquired portosystemic shunts in dogs after extrahepatic portosystemic shunt attenuation. J Vet Intern Med 2023; 37:1760-1765. [PMID: 37596730 PMCID: PMC10473046 DOI: 10.1111/jvim.16781] [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: 10/12/2022] [Accepted: 05/11/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND In dogs with portal hypertension (PH), spec cPL is suggested to be increased despite normal pancreatic histology. After attenuation of congenital extrahepatic portosystemic shunts (cEHPSS), multiple acquired portosystemic shunt (MAPSS) can develop as consequence of sustained PH. Presence of MAPSS affects future therapeutic options and prognosis. OBJECTIVE Evaluate if spec cPL concentrations increase postoperatively in dogs that develop MAPSS and can thus serve as an indicator of PH. ANIMALS Twenty-four dogs with cEHPSS. METHODS Dogs classified according to surgical outcome after cEHPSS attenuation (8 with MAPSS [group M], 9 with closed cEHPSS [group C] and 7 with patent blood flow through the original cEHPSS, without evidence of MAPSS [group P]). Spec cPL was measured in preoperative samples (T0), 4 days (T1) and 1 (T2) and 3- to 6-months (T3) after surgery. RESULTS Spec cPL was within reference interval (<200 μg/L) at all timepoints except at T1. At T1, 2 dogs in group M (321 and >2000 μg/L) and also 1 in group C (688 μg/L) and 1 in group P (839 μg/L) had increased spec cPL concentrations. No differences in spec cPL concentrations between groups or changes over time were identified. CONCLUSIONS AND CLINICAL IMPORTANCE Spec cPL is not consistently increased in dogs that develop MAPSS after cEHPSS attenuation and has no potential as a biomarker for the identification of MAPSS after cEHPSS attenuation.
Collapse
Affiliation(s)
- Gonçalo Serrano
- Small Animal DepartmentGhent University, Faculty of Veterinary MedicineMerelbekeBelgium
- Evidensia Hart van BrabantWaalwijkNetherlands
| | - Nausikaa Devriendt
- Small Animal DepartmentGhent University, Faculty of Veterinary MedicineMerelbekeBelgium
| | - Hilde de Rooster
- Small Animal DepartmentGhent University, Faculty of Veterinary MedicineMerelbekeBelgium
| |
Collapse
|
5
|
Lipscomb V, Cassie C, Ritchie B, Greenhalgh S, Tivers M. Prospective Study Comparing Outcome following Complete Polypropylene Suture Ligation versus Partial Thin Film Band Attenuation of Congenital Portosystemic Shunts in Dogs. Vet Sci 2023; 10:480. [PMID: 37505884 PMCID: PMC10383284 DOI: 10.3390/vetsci10070480] [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: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
The main objective was to conduct a prospective study reporting the outcome for dogs with an extrahepatic congenital portosystemic shunt (CPSS) treated with a 'complete ligation where possible' philosophy. The second aim was to compare the outcomes following complete (C) polypropylene suture ligation versus partial thin film band (TFB) attenuation of a CPSS in dogs. Dogs that could not tolerate acute complete shunt ligation at surgery received partial shunt attenuation with TFB. Peri-operative complications, mortality, follow-up imaging findings, pre- and post-operative bile acid stimulation test results and details of any revision surgery performed were recorded. A follow-up health-related quality of life questionnaire enabled the calculation of a postoperative clinical shunt score, a quality of life score, and determined if any dogs were still on a hepatic diet and/or other medical management at a minimum of 6 months after surgery. Of the 110 dogs enrolled, 57 received complete ligation and 53 received partial TFB attenuation. Peri-operative mortality, the occurrence of post-attenuation neurological complications, the occurrence of multiple acquired shunts, the postoperative clinical shunt score and quality of life score were not significantly different between the two groups. Dogs in the C group were older, heavier and demonstrated a greater number of shunt classifications where the entry into the systemic circulation was the phrenic vein or azygous vein. Dogs in the TFB group had a greater number of unchanged bile acid concentrations after surgery, were more likely to remain on the hepatic diet and/or medical management after surgery and underwent a greater number of revision surgeries. There was variability in the precision of both ultrasound and computed tomographic angiography follow-up imaging compared to intra-operative mesenteric portovenography findings at revision surgery. Overall, dogs with an extrahepatic portosystemic shunt receiving either complete acute shunt ligation or partial TFB shunt attenuation are expected to have an excellent long-term clinical outcome and there is no reason to suggest that a dog able to tolerate complete acute shunt closure should be denied the benefit of this.
Collapse
Affiliation(s)
- Victoria Lipscomb
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield AL9 7TA, UK
| | - Chloe Cassie
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield AL9 7TA, UK
| | - Ben Ritchie
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield AL9 7TA, UK
| | - Stephen Greenhalgh
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield AL9 7TA, UK
| | | |
Collapse
|
6
|
Lipscomb V, Tivers M, Kummeling A, van Sluijs F. Portovenography Findings Following Partial Polypropylene Versus Thin Film Band Attenuation of a Single Congenital Extrahepatic Portosystemic Shunt: A Prospective Randomized Study in Dogs. Vet Sci 2023; 10:vetsci10050353. [PMID: 37235436 DOI: 10.3390/vetsci10050353] [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: 04/10/2023] [Revised: 04/30/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
The objective was to conduct a prospective, randomized study to compare mesenteric portovenogram findings following partial polypropylene suture versus thin film band extrahepatic portosystemic shunt attenuation in dogs. Dogs with extrahepatic portosystemic shunts that could not tolerate complete acute shunt closure received a partial attenuation with either a polypropylene suture or synthetic polymer thin film band. At a routine second surgery three months after shunt patency, missed shunt branches and/or development of multiple acquired shunts were assessed using intra-operative mesenteric portovenography. Twenty-four dogs were enrolled, 12 received partial polypropylene suture ligation, and 12 received partial thin film band shunt attenuation. Intra-operative mesenteric portovenography three months later demonstrated that nine dogs (75%) in the thin film band group had achieved complete shunt closure versus two dogs (16.7%) in the polypropylene suture group, which was significantly different (p = 0.004). No dogs in the polypropylene suture group and two dogs (16.7%) in the thin film band group developed multiple acquired shunts. This is the first study directly comparing follow-up intra-operative mesenteric portovenography imaging findings between two methods of partial portosystemic shunt attenuation in dogs. The study provides accurate information on the rates of complete anatomical shunt closure and development of multiple acquired shunts following partial shunt attenuation with either synthetic polymer thin film band or polypropylene suture.
Collapse
Affiliation(s)
- Victoria Lipscomb
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire AL9 7TA, UK
| | - Mickey Tivers
- Paragon Veterinary Referrals, Wakefield, West Yorkshire WF1 2DF, UK
| | - Anne Kummeling
- Department Clinical Sciences, Faculty of Veterinary Medicine, 3584 CL Utrecht, The Netherlands
| | - Freek van Sluijs
- Department for Small Animals, Vetsuisse Faculty, CH-8057 Zurich, Switzerland
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Schikowski L, Schaub S, Thalmeier S, Schneider M. Imaging findings in a minipig with congenital portosystemic shunt. TIERÄRZTLICHE PRAXIS AUSGABE K: KLEINTIERE / HEIMTIERE 2022; 50:370-375. [DOI: 10.1055/a-1913-2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractA 15-month-old, male minipig was presented with a clinical history of seizure activity for one year. The minipig was the smallest among the littermates and was referred due to an elevated blood ammonia level with suspected portosystemic shunt (PSS). Ultrasound and CT angiography were consistent with a congenital extrahepatic PSS. To the author’s knowledge, this is the first description of a congenital extrahepatic PSS diagnosed by ultrasound and contrast-enhanced computed tomography in a minipig (pig). Partial shunt closure was performed by interventional stent application.
Collapse
Affiliation(s)
- Lisa Schikowski
- Small Animal Clinic, Surgery, Justus-Liebig-University Giessen
| | | | - Sabine Thalmeier
- Small Animal Clinic, Internal Medicine, Justus-Liebig-University Giessen
| | - Matthias Schneider
- Small Animal Clinic, Internal Medicine, Justus-Liebig-University Giessen
| |
Collapse
|
10
|
Glenn O, Tomlinson A, Pinchbeck G, Burrow R. Short‐ and long‐term outcomes of polyethylene band attenuation of congenital extrahepatic portosystemic shunts in dogs: 60 cases (2010‐2020). J Small Anim Pract 2022; 63:882-889. [PMID: 36089752 PMCID: PMC10087761 DOI: 10.1111/jsap.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/11/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report the short- and long-term outcomes following attenuation of congenital extrahepatic portosystemic shunts in dogs using a novel polyethylene band. MATERIALS AND METHODS Records were retrospectively reviewed for dogs that underwent congenital extrahepatic portosystemic shunt attenuation by a polyethylene banding technique, at a single institution between 2010 and 2020. Short-term outcome data were collected from peri-operative clinical records with follow-up examinations, scheduled at 6 and 18 weeks post-operatively, and post-operative imaging when performed. Long-term follow-up was collected by validated owner questionnaire, telephone interview or medical records. Long-term outcomes were categorised by "excellent", "good" or "poor". RESULTS Sixty dogs were included. Post-operative complications occurred in 10 of 60 dogs (16.7%), four major and six minor, with a peri-operative mortality of 6.7%. Persistent shunting was identified in nine of 53 dogs (17%) available for follow-up examination and four dogs underwent a revision surgery. Long-term follow-up was available for 44 dogs at a median of 75 months post-operatively (range 7 to 128). Long-term outcomes were "excellent" (26) or "good" (8) in 81.8% of dogs and "poor" (8) in 18.2%. At the time of follow-up, 30 of 44 (68.2%) dogs were not receiving any medical treatment and 27 of 28 (96.4%) questionnaire respondents were satisfied with the response to surgery. CLINICAL SIGNIFICANCE Polyethylene band attenuation of congenital extrahepatic portosystemic shunts provides comparable outcomes to cellophane. The material used in this study is widely available and consistent while being pre-sterilised and pre-folded makes it easy to use.
Collapse
Affiliation(s)
- O. Glenn
- Royal (Dick) School of Veterinary StudiesThe University of Edinburgh Easter Bush CampusMidlothianEH25 9RGUK
| | - A. Tomlinson
- Small Animal Teaching HospitalUniversity of Liverpool, LeahurstNestonCH64 7TEUK
| | - G. Pinchbeck
- Institute of Infection, Veterinary and Ecological SciencesUniversity of Liverpool. LeahurstNestonCH64 7TEUK
| | - R. Burrow
- Northwest Veterinary SpecialistsCheshireWA7 3FWUK
| |
Collapse
|
11
|
Casha G, Jones C. Intercostal thoracotomy for surgical attenuation of portoazygos extrahepatic portosystemic shunts in three dogs: surgical technique and short-term outcomes. N Z Vet J 2022; 70:332-339. [PMID: 35924343 DOI: 10.1080/00480169.2022.2108153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
CASE HISTORIES The medical records of three dogs, presenting to the surgery department at a tertiary private referral hospital (Cork, Republic of Ireland), were retrospectively reviewed. The patients presented for investigation of a 3-day history of progressive lethargy, decreased appetite and hindlimb weakness (Case 1); brachycephalic obstructive airway syndrome and the development of abnormal licking behaviours (Case 2); and a 2-month history of increased thirst with elevated alanine aminotransferase in serum (Case 3). CLINICAL FINDINGS Case 1 presented with tachycardia, hindlimb paraparesis and neck pain, while Case 2 presented with facial conformation abnormalities consistent with brachycephalic obstructive airway syndrome. General physical examination and neurological assessment were within normal limits for Case 3. Baseline serum biochemistry measurements, in all three patients, indicated elevated activities of alanine aminotransferase and alkaline phosphatase, as well as elevated concentrations of resting bile acids (BA), suggestive of an extrahepatic portosystemic shunt. Abdominal computed tomography (CT) angiography was performed, for each dog, which revealed the presence of a portoazygous shunt (PAS) with final insertion into the caudal azygos vein within the thorax. TREATMENT AND OUTCOME Abdominal CT angiography images were used for surgical planning and a right-sided intercostal thoracotomy was performed. The location of the thoracotomy was patient-specific and located cranial to the diaphragm, either at the point of PAS insertion into the azygos vein or one rib-space caudal to the insertion, as determined by pre-operative CT images. The intercostal thoracotomy provided good visualisation of the PAS and an appropriate surgical field for placement of a thin film band around the PAS. No surgical complications or post-attenuation seizures were observed. All patients appeared comfortable on oral analgesia and were discharged from the hospital by 48 hours after surgery. All patients demonstrated a clinical improvement when reassessed 6-8 weeks after surgery, and Cases 2 and 3 demonstrated a reduction of resting BA concentrations to within normal limits. The third patient (Case 1) had a considerable reduction in the concentration of resting BA from >140 µmol/L to 20 µmol/L (reference range 0-10 µmol/L) 6-8 weeks after surgery. CLINICAL RELEVANCE A right-sided intercostal thoracotomy can be considered for surgical management of PAS in dogs. While both intraoperative and short-term results appear promising, further prospective studies are required before this approach can be recommended as the preferred approach for PAS attenuation.
Collapse
Affiliation(s)
- G Casha
- Gilabbey Veterinary Hospital, Cork, Republic of Ireland
| | - C Jones
- Gilabbey Veterinary Hospital, Cork, Republic of Ireland
| |
Collapse
|
12
|
Devriendt N, Serrano G, Paepe D, Vandenabeele S, Stock E, de Rooster H. Persistent hypercobalaminemia three months after successful gradual attenuation of extrahepatic shunts in dogs: a prospective cohort study. BMC Vet Res 2022; 18:18. [PMID: 34991571 PMCID: PMC8734341 DOI: 10.1186/s12917-021-03123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Deficiencies in vitamin A and D and disorders in the vitamin B complex are often present in people with chronic liver diseases. So far, the serum concentrations of these vitamins have not yet been studied in dogs with congenital extrahepatic portosystemic shunts (EHPSS), who also have some degree of liver dysfunction. The objective was to assess serum vitamin concentrations in dogs with EHPSS from diagnosis to complete closure. A prospective cohort study was performed using ten client-owned dogs with EHPSS, closed after gradual surgical attenuation. Serum concentrations of vitamin A, 25-hydroxyvitamin D, folic acid, cobalamin and methylmalonic acid (MMA) were measured at diagnosis prior to institution of medical therapy, prior to surgery, and three months after gradual attenuation and complete closure of the EHPSS. Results At diagnosis, median serum concentrations of vitamin A, 25-hydroxyvitamin D and folic acid were 18.2 μg/dL (8.8 - 79.5 μg/dL), 51.8 ng/mL (19.4 - 109.0 ng/mL), and 8.1 μg/L (5.2 - 14.5 μg/L), respectively, which increased significantly postoperatively (88.3 μg/dL (51.6 - 182.2 μg/dL, P=0.005), 89.6 ng/mL (49.3 - >150.0 ng/mL, P =0.005), and 14.8 μg/L (11.5 - 17.7 μg/L, P <0.001), respectively). Median serum cobalamin concentrations were 735.5 ng/L (470 - 1388 ng/L) at diagnosis and did not significantly decrease postoperatively (P =0.122). Both at diagnosis and three months postoperatively 7/10 dogs had hypercobalaminemia. Conclusions Serum concentrations of vitamin A, 25-hydroxyvitamin D and folic acid significantly increase after surgical attenuation. Nevertheless, persistent hypercobalaminemia is suggestive of ongoing liver dysfunction, despite successful surgery.
Collapse
Affiliation(s)
- Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium.
| | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Sophie Vandenabeele
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Emmelie Stock
- Department of Medical Imaging of Domestic Animals and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| |
Collapse
|
13
|
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]
|
14
|
Escribano Carrera A, Morrissey AM, Lipscomb VJ, Tivers MS, Chan A, Lisa Pinel Pisco V, Anderson DM, Fox-Alvarez WA, Kirby Dvm BM, de Rooster H, Nurra G, Yool DA, Singh A, Olive M, Phillipe Billet J, Mullins RA. Long-term outcome and quality of life of dogs that developed neurologic signs after surgical treatment of a congenital portosystemic shunt: 50 cases (2005-2020). J Am Vet Med Assoc 2021; 260:326-334. [PMID: 34793328 DOI: 10.2460/javma.20.11.0606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine survival time and quality of life of dogs that developed postattenuation neurologic signs (PANS) after surgical treatment of a single congenital portosystemic shunt and survived at least 30 days and identify whether neurologic signs present at the time of discharge would resolve or reoccur. ANIMALS 50 client-owned dogs. PROCEDURES Medical records were retrospectively reviewed, and follow-up data relating to neurologic signs and seizure activity were obtained. Owners were asked to complete a questionnaire related to the presence of neurologic signs, including seizures, and their dog's quality of life. RESULTS Thirty of the 50 (60%) dogs had postattenuation seizures with or without other nonseizure neurologic signs, and 20 (40%) had neurologic signs other than seizures. Neurologic signs had fully resolved by the time of discharge in 24 (48%) dogs. Signs resolved in 18 of the remaining 26 (69%) dogs that still had PANS other than seizures at the time of discharge. Seizures reoccurred in 15 of the 30 dogs that had postattenuation seizures. Twenty-seven of 33 (82%) owners graded their dog's long-term (> 30 days after surgery) quality-of-life as high. Forty-five (90%) dogs survived > 6 months. Most (29/43 [67%]) neurologic signs (other than seizures) present at the time of hospital discharge resolved. CLINICAL RELEVANCE Findings highlighted that survival times of > 6 months and a high QOL can be achieved in most dogs with PANS that survive at least 30 days. Most neurologic signs other than seizures resolved within 1 month postoperatively. Half of the dogs with postattenuation seizures had a reoccurrence.
Collapse
Affiliation(s)
- Antía Escribano Carrera
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Anya M Morrissey
- Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, UK
| | - Victoria J Lipscomb
- Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, UK
| | - Michael S Tivers
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol, UK
| | - Alex Chan
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol, UK
| | | | | | - William A Fox-Alvarez
- Department of Small Animal Clinical Science, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Barbara M Kirby Dvm
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, University of Ghent, Merelbeke, Belgium
| | - Genziana Nurra
- School of Veterinary Medicine, University of Glasgow, Bearsden, Glasgow, UK
| | - Donald A Yool
- School of Veterinary Medicine, University of Glasgow, Bearsden, Glasgow, UK
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Melanie Olive
- Centre Hospitalier Vétérinaire Atlantia, Nantes, France
| | | | - Ronan A Mullins
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| |
Collapse
|
15
|
Mullins RA, Escribano Carrera A, Anderson DM, Billet JP, Brissot H, Broome C, de Rooster H, Kirby BM, Pratschke KM, Tivers MS, White RN, Yool DA, Youmans KR. Postattenuation neurologic signs after surgical attenuation of congenital portosystemic shunts in dogs: A review. Vet Surg 2021; 51:23-33. [PMID: 34585759 DOI: 10.1111/vsu.13729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/26/2021] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
The development of postattenuation neurologic signs (PANS) is a poorly understood and potentially devastating complication after surgical attenuation of congenital portosystemic shunts in dogs. Postattenuation neurologic signs include seizures but also more subtle neurologic signs such as depression, behavioral changes, tremors, and twitching. They most commonly occur within 7 days postoperatively and are typically unrelated to hyperammonemia, hypoglycemia, or electrolyte disturbances. This narrative review summarizes the findings of 50 publications from 1988-2020 that report occurrence of PANS. While most published reports included only dogs affected by postattenuation seizures (PAS), others included dogs with any form of PANS. Overall, PANS (including PAS) affected 1.6%-27.3% of dogs, whereas incidence of PAS ranged from 0%-18.2%. The etiology of PANS remains unknown; however, several theories have been proposed. Risk factors include preoperative hepatic encephalopathy, increasing age, and possibly certain breeds and extrahepatic shunt morphology. There is increasing evidence that prophylactic antiepileptic drugs do not prevent PANS. Treatment is centered around controlling neurologic signs with antiepileptic drugs and providing supportive intensive care. The 30-day survival rate in studies that included a minimum of four dogs affected by PANS was 0%-100% (median, 50.0%) and 0%-75.0% (median, 37.5%) for those with PAS. Mortality associated with PANS was typically related to occurrence of generalized seizure activity. Prognostic factors positively associated with short-term survival included having a history of preoperative seizures and development of focal seizures only. If affected dogs survived to discharge, survival for several years was possible, and the majority of neurologic signs manifested as part of the phenomenon of PANS appeared to resolve.
Collapse
Affiliation(s)
- Ronan A Mullins
- Section of Small Animal Clinical Sciences, University College Dublin, Dublin, Ireland
| | | | | | | | | | - Cameron Broome
- Veterinary Referral Hospital, Melbourne, Victoria, Australia
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Barbara M Kirby
- Section of Small Animal Clinical Sciences, University College Dublin, Dublin, Ireland
| | - Kathryn M Pratschke
- Veterinary Clinical Services, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Easter Bush Campus, Midlothian EH25 9RG, UK
| | - Michael S Tivers
- Paragon Veterinary Referrals, Paragon Business Village, Red Hall Crescent, Wakefield, UK
| | - Robert N White
- School of Veterinary Medicine & Science, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | - Donald A Yool
- University of Glasgow, School of Veterinary Medicine, Glasgow, UK
| | | |
Collapse
|
16
|
Terpstra M, Gough SL, Parry AT, Loomes K, Harkness A, Rendle DI, Dixon JJ. Presentation, stabilisation and contrast‐enhanced computed tomographic (CT) diagnosis of a left gastrocaval portosystemic shunt in a pony foal. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- M. Terpstra
- Rainbow Equine Hospital Old Malton, North Yorkshire UK
| | - S. L. Gough
- Rainbow Equine Hospital Old Malton, North Yorkshire UK
| | - A. T. Parry
- Willows Veterinary Centre and Referral Service Shirley, Solihull UK
| | - K. Loomes
- Rainbow Equine Hospital Old Malton, North Yorkshire UK
| | - A. Harkness
- Rainbow Equine Hospital Old Malton, North Yorkshire UK
| | - D. I. Rendle
- Rainbow Equine Hospital Old Malton, North Yorkshire UK
| | - J. J. Dixon
- Rainbow Equine Hospital Old Malton, North Yorkshire UK
| |
Collapse
|
17
|
Devriendt N, Paepe D, Serrano G, Vandenabeele S, Stock E, Van Acker L, de Rooster H. Plasma amino acid profiles in dogs with closed extrahepatic portosystemic shunts are only partially improved 3 months after successful gradual attenuation. J Vet Intern Med 2021; 35:1347-1354. [PMID: 33949730 PMCID: PMC8162604 DOI: 10.1111/jvim.16135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dogs with portosystemic shunts have an altered blood amino acid profile, with an abnormal branched-chained amino acid (BCAA)-to-aromatic amino acid (AAA) ratio being the most common abnormality. Different liver diseases have distinctive amino acid profiles. OBJECTIVES Determine the changes in plasma amino acid profiles in dogs with extrahepatic portosystemic shunts (EHPSS) from diagnosis to complete closure. ANIMALS Ten client-owned dogs with EHPSS closed after surgical attenuation. METHODS Prospective cohort study. Medical treatment was instituted in dogs diagnosed with EHPSS. At least 4 weeks later, gradual surgical attenuation was performed. Three months postoperatively, EHPSS closure was confirmed by transsplenic portal scintigraphy. Clinical signs were scored and blood was taken before institution of medical treatment, at time of surgery, and 3 months postoperatively. At the end of the study, the plasma amino acid profiles were analyzed in batch. RESULTS The median BCAA-to-AAA ratio was extremely low (0.6) at time of diagnosis and remained low (0.5) at time of surgery, despite the fact that median neurological score significantly improved from 22 to 2 after starting medical treatment (P = .04). Three months after surgical attenuation, a significantly higher BCAA-to-AAA ratio (1.5) was observed (P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE Medical treatment does not improve the BCAA-to-AAA ratio in dogs with EHPSS, despite substantial clinical improvement. Although the ratio significantly increased after EHPSS closure, it was still indicative of moderate to severe hepatic dysfunction in all dogs.
Collapse
Affiliation(s)
- Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Sophie Vandenabeele
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Emmelie Stock
- Department of Medical Imaging of Domestic Animals and Small Animal Orthopaedics, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Lisa Van Acker
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| |
Collapse
|
18
|
Kim TY, Kim D, Yoon J, Kim S, Yi SW, Oh WT, Park JY, Kim H, Kang M, Lee JB, Sung H. External Self‐Closing Tube to Occlude a Vessel Gradually as a Therapeutic Means of Portosystemic Shunt. ADVANCED THERAPEUTICS 2020. [DOI: 10.1002/adtp.202000039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Tae Young Kim
- Department of Medical EngineeringYonsei University College of Medicine 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Dae‐Hyun Kim
- Department of Medical EngineeringYonsei University College of Medicine 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Jeong‐Kee Yoon
- Department of Medical EngineeringYonsei University College of Medicine 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Surim Kim
- Department of Medical EngineeringYonsei University College of Medicine 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Se Won Yi
- TMD Lab., Co., Ltd. 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Won Taek Oh
- TMD Lab., Co., Ltd. 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Ju Young Park
- TMD Lab., Co., Ltd. 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Hye‐Seon Kim
- Department of Medical EngineeringYonsei University College of Medicine 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Mi‐Lan Kang
- TMD Lab., Co., Ltd. 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| | - Jung Bok Lee
- Department of Biological ScienceSookmyung Women's University Seoul 04310 Republic of Korea
| | - Hak‐Joon Sung
- Department of Medical EngineeringYonsei University College of Medicine 50‐1 Yonsei‐ro, Seodaemun‐gu Seoul 03722 Republic of Korea
| |
Collapse
|
19
|
Mullins RA, Sanchez Villamil C, Selmic LE, Tivers MS, Case JB, Singh A, Thieman Mankin KM, Anderson DM, White RN, Pratschke KM, de Rooster H, Kummeling A, Yool DA, Olive M, Dr Vét JPB, Gordo I, Brissot H, Broome C, Kirby BM. Prognostic factors for short-term survival of dogs that experience postattenuation seizures after surgical correction of single congenital extrahepatic portosystemic shunts: 93 cases (2005-2018). Vet Surg 2020; 49:958-970. [PMID: 32246785 DOI: 10.1111/vsu.13422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/03/2018] [Accepted: 01/26/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To identify prognostic factors for short-term survival of dogs that experience seizures within 7 days after surgical correction of single congenital extrahepatic portosystemic shunts (cEHPSS). STUDY DESIGN Multi-institutional retrospective study. SAMPLE POPULATION Ninety-three client-owned dogs. METHODS Medical records at 14 veterinary institutions were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 1, 2005 through February 28, 2018 and experienced postattenuation seizures (PAS) within 7 days postoperatively. Logistic regression analysis was performed to identify factors associated with 1-month survival. Factors investigated included participating institution, signalment, shunt morphology, concurrent/historical conditions, presence of preoperative neurologic signs, presence of preoperative seizures, aspects of preoperative medical management, surgical details including method and degree of shunt attenuation, type of PAS (focal only or generalized ± focal), drugs administered as part of the treatment of PAS, and development of complications during treatment of PAS. RESULTS Thirty (32.3%) dogs survived to 30 days. Seventy-six (81.7%) dogs experienced generalized PAS. Factors positively associated with short-term survival included having a history of preoperative seizures (P = .004) and development of focal PAS only (P = .0003). Most nonsurvivors were humanely euthanized because of uncontrolled or recurrent seizures. CONCLUSION Dogs that experienced PAS that had a history of preoperative seizures and those that experienced focal PAS only had significantly improved short-term survival. CLINICAL SIGNIFICANCE The results of this study provide information that will help in the counseling of owners who seek treatment for PAS after surgical correction of cEHPSS. © 2020 The American College of Veterinary Surgeons.
Collapse
Affiliation(s)
- Ronan A Mullins
- Section of Veterinary Clinical Sciences, University College Dublin, Belfield, Dublin, Ireland
| | - Carlos Sanchez Villamil
- Section of Veterinary Clinical Sciences, University College Dublin, Belfield, Dublin, Ireland
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio
| | - Michael S Tivers
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol, United Kingdom
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Kelley M Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Davina M Anderson
- Anderson Moores Veterinary Specialists, Hursley, Winchester, United Kingdom
| | - Robert N White
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, United Kingdom.,School of Veterinary Medicine & Science, University of Nottingham, Sutton Bonington Campus, Loughborough, United Kingdom
| | - Kathryn M Pratschke
- University of Glasgow, School of Veterinary Medicine, Bearsden, Glasgow, United Kingdom
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Anne Kummeling
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
| | - Donald A Yool
- The Royal (Dick) School of Veterinary Studies, Easter Bush Campus, Midlothian, Edinburgh, United Kingdom
| | - Melanie Olive
- Centre Hospitalier Vétérinaire Atlantia, Nantes, France
| | | | - Ines Gordo
- Pride Veterinary Centre, Derby, Derbyshire, United Kingdom
| | - Herve Brissot
- Pride Veterinary Centre, Derby, Derbyshire, United Kingdom
| | - Cameron Broome
- University of Glasgow, School of Veterinary Medicine, Bearsden, Glasgow, United Kingdom
| | - Barbara M Kirby
- Section of Veterinary Clinical Sciences, University College Dublin, Belfield, Dublin, Ireland
| |
Collapse
|
20
|
Li H, Dupré G, Liu R, Yuan Z, Li J. Staged closure of a congenital porto‐internal thoracic shunt in a cat. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Hui Li
- Veterinary Teaching HospitalDepartment of clinical veterinary medicineChina Agricultural UniversityBeijingChina
| | - Gilles Dupré
- Department for Companion Animals and HorsesUniversity of Veterinary Medicine ViennaWienWienAustria
| | - Ran Liu
- Veterinary Teaching HospitalDepartment of clinical veterinary medicineChina Agricultural UniversityBeijingChina
| | - Zhankui Yuan
- Veterinary Teaching HospitalDepartment of clinical veterinary medicineChina Agricultural UniversityBeijingChina
| | - Jing Li
- Veterinary Teaching HospitalDepartment of clinical veterinary medicineChina Agricultural UniversityBeijingChina
| |
Collapse
|
21
|
Otomo A, Singh A, Jeong J, Dobberstein R, Lundhild A, Peter E, Brisson B, Oblak M, Milovancev M. Long-term clinical outcomes of dogs with single congenital extrahepatic portosystemic shunts attenuated with thin film banding or ameroid ring constrictors. Vet Surg 2020; 49:436-444. [PMID: 31971276 DOI: 10.1111/vsu.13384] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 12/16/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare long-term clinical outcomes of dogs with single congenital extrahepatic portosystemic shunts (CEHPSS) treated with thin film banding (TFB) consisting of polyolefin fiber or ameroid ring constrictor (ARC) placement in dogs. DESIGN Retrospective, two-center clinical study. ANIMALS Client-owned dogs (n = 123) with single CEHPSS undergoing gradual attenuation via TFB (n = 85) or ARC (n = 38). METHODS Medical records of dogs with CEHPSS were reviewed. Follow-up data were collected from the referring veterinarian and/or owner via standardized questionnaire. Data were analyzed to compare short-term mortality rate and long-term outcome (>6 months). RESULTS Dogs in the TFB group were older than dogs in the ARC group (median age, 19 vs 12 months, respectively; P = .01). There was no difference in survival to discharge between dogs in the TFB (81/85 [95.3%]) and ARC (37/38 [97.4%]; P > .99) groups. Preoperative levetiracetam was more frequently administered to dogs treated with TFB (64/85 [75.3%]) than to dogs treated with ARC (15/38 [39.5%;] P = .0002). Postoperative seizures were reported in 10 (8.1%) dogs; their prevalence did not differ between dogs treated with TFB (9/85 [10.6%]) and dogs treated with ARC (1/38 [2.6%]; P = .17). Median follow-up time for dogs treated with TFB (58.0 months, range 8-130) and ARC (63.3 months, range 7-138; P = .24) did not differ. CONCLUSION Gradual attenuation of a single CEHPSS with either TFB or ARC resulted in similar long-term clinical outcomes and low postoperative morbidity and mortality rates. CLINICAL SIGNIFICANCE Thin film banding (polyolefin fiber) offers an alternative leading to clinical outcomes similar to ARC in dogs with single CEHPSS.
Collapse
Affiliation(s)
- Aki Otomo
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.,Department of Veterinary Clinical Sciences, Louisiana State University, School of Veterinary Medicine, Baton Rouge, Louisiana
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Junemoe Jeong
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon
| | - Rachel Dobberstein
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Alexandra Lundhild
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Elyse Peter
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Brigitte Brisson
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Michelle Oblak
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Milan Milovancev
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon
| |
Collapse
|
22
|
Freund KA, Wallace ML, Secrest SA, Lieske DE. Thin film occlusion of an intra-abdominal vein in cats. Vet Surg 2019; 49:354-362. [PMID: 31785019 DOI: 10.1111/vsu.13365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/16/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the occlusion of an intra-abdominal vessel as a model of an extrahepatic portosystemic shunt by thin film banding in a controlled setting and to document histologically the perivascular region's response to thin film banding after 8 weeks. STUDY DESIGN Experimental study. ANIMALS Six purpose-bred healthy domestic short hair cats. METHODS Thin film bands were placed around the external iliac vein, with a sham procedure on the contralateral vessel. Closure rates were monitored via computed tomographic angiography (CTA) every 2 weeks for a total of 8 weeks. After 8 weeks, the vessels were resected, if possible, and submitted for histopathologic evaluation. RESULTS All cats tolerated the procedure without surgical complications. Eight weeks after surgery, closure was evaluated as complete in one cat, marked in two cats, moderate in one cat, and mild in two cats according to CTA. Histological examination (in three cats) was consistent with chronic, multifocal, granulomatous inflammation with moderate fibrosis and collagen degeneration. CONCLUSION Venous occlusion was inconsistent and often incomplete 8 weeks after thin film banding of the external iliac vein despite the presence of moderate to abundant perivascular fibrous tissue. CLINICAL SIGNIFICANCE Vascular occlusion by thin film banding in cats is mainly incomplete after 2 months. This study supports the theory that high level of residual shunting may be expected in some cats after thin film banding.
Collapse
Affiliation(s)
- Kristin A Freund
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Mandy L Wallace
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Scott A Secrest
- Department of Veterinary Biosciences and Diagnostic Imaging, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Danielle E Lieske
- Department of Veterinary Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| |
Collapse
|
23
|
Serrano G, Charalambous M, Devriendt N, de Rooster H, Mortier F, Paepe D. Treatment of congenital extrahepatic portosystemic shunts in dogs: A systematic review and meta-analysis. J Vet Intern Med 2019; 33:1865-1879. [PMID: 31471995 PMCID: PMC6766526 DOI: 10.1111/jvim.15607] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/20/2019] [Indexed: 11/27/2022] Open
Abstract
Background Several options have been proposed for the treatment of congenital extrahepatic portosystemic shunts (cEHPSS) in dogs, but formal comparisons among different treatment options are currently unavailable. A previous evidence‐based review (2012) found low quality of evidence for papers assessing the treatment of cEHPSS in dogs. Objectives To assess the quality of evidence available in the treatment of cEHPSS, summarize the current state of knowledge with respect to outcome after cEHPSS management, and compare different treatment techniques. Animals Not used. Methods A bibliographic search was performed without date or language restrictions. Studies were assessed for quality of evidence (study design, study group sizes, subject enrollment quality, and overall risk of bias) and outcome measures reported (perioperative outcome, clinical outcome, and surgical or interventional outcome), all reported with 95% confidence intervals. A network meta‐analysis was performed. Results Forty‐eight studies were included. Six retrospective studies (grade 4b) compared 2 techniques and 7 were abstracts (grade 5). The quality of evidence was low and risk of bias high. Regarding surgical outcome, statistically significant superiority of ameroid constrictor over thin film band was observed (P = .003). No other comparisons were statistically significant. Conclusions and Clinical Importance The evidence base of choice of treatment of cEHPSS in dogs remains weak despite recent publications on the subject. Ameroid is superior to thin film band in causing EHPSS closure. Blinded randomized studies comparing different treatment modalities, which routinely include postoperative imaging to assess cEHPSS closure and acquired portosystemic shunt development are essential.
Collapse
Affiliation(s)
- Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Marios Charalambous
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Femke Mortier
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| |
Collapse
|
24
|
Field E, Scurr DJ, Piggott MJ, Anderson TS, Chanoit GP. The chemical and ultra-structural analysis of thin plastic films used for surgical attenuation of portosystemic shunts in dogs and cats. Res Vet Sci 2019; 126:192-198. [PMID: 31539796 DOI: 10.1016/j.rvsc.2019.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 11/16/2022]
Abstract
The objective of the study was to (1) characterize and compare the chemical composition at the surface, subsurface and in the bulk of thin plastic films used for portosystemic shunt attenuation in their native state and after plasma exposure. (2) Assess the presence, concentration and location of irritant compounds (e.g dicetyl phosphate) within the films. Attenuated Total Reflectance Infrared Spectroscopy (ATR-IR), X-ray Photoelectron Spectroscopy (XPS) and dynamic Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS) were used to analyze thirteen thin plastic films. Sample thickness was visualized and measured using Scanning Electron Microscopy (SEM). Sample thicknesses were compared using a one-way ANOVA. XPS reported low phosphorous concentrations (surrogate marker of dicetyl phosphate) between 0.01 and 0.19% wt at the sample surfaces (top 10 nm). There were significant differences between film thicknesses (P < .001) observed by SEM. The ATR-IR and ToF-SIMS identified four distinct surface and bulk chemical profiles: 1) Cellophane, 2) Polypropylene, 3) Modified Cellophane, and 4) Unique. Following plasma immersion for 6 weeks, samples showed little change in film thickness or chemical composition. This study confirmed that films used to attenuate portosystemic shunts were commonly not pure cellophane, with significant variations in surface and bulk chemistry. Suspected irritant compounds were not readily identifiable in significant proportions. Pronounced variability existed in both the thickness and chemical composition of these films (surface vs. bulk). The present findings lead to a legitimate question about the reproducibility of shunt occlusion when using thin plastic films from different origins.
Collapse
Affiliation(s)
- ElinorJ Field
- University of Bristol, Faculty of Health and Science, Bristol Veterinary School, UK
| | - David J Scurr
- University of Nottingham, School of Pharmacy, Advanced Materials and Healthcare Technologies, UK
| | - Matthew J Piggott
- University of Nottingham, School of Pharmacy, Advanced Materials and Healthcare Technologies, UK
| | - Thomas S Anderson
- University of Bristol, Faculty of Health and Science, Bristol Veterinary School, UK
| | - Guillaume P Chanoit
- University of Bristol, Faculty of Health and Science, Bristol Veterinary School, UK.
| |
Collapse
|
25
|
Mullins RA, Sanchez Villamil C, de Rooster H, Kummeling A, White RN, Thieman Mankin KM, Tivers MS, Yool DA, Anderson DM, Pratschke KM, Gordo I, Brissot H, Singh A, Olive M, Billet JP, Selmic LE, Kirby BM. Effect of prophylactic treatment with levetiracetam on the incidence of postattenuation seizures in dogs undergoing surgical management of single congenital extrahepatic portosystemic shunts. Vet Surg 2018; 48:164-172. [DOI: 10.1111/vsu.13141] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/12/2018] [Accepted: 11/06/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Ronan A. Mullins
- Section of Veterinary Clinical Sciences; University College Dublin; Belfield Dublin Ireland
| | | | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - Anne Kummeling
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine; Utrecht University; Utrecht The Netherlands
| | - Robert N. White
- Willows Veterinary Centre and Referral Service; Shirley, Solihull West Midlands United Kingdom
- Abbey House Veterinary Hospital; Morley Leeds United Kingdom
- School of Veterinary Medicine & Science; University of Nottingham, Sutton Bonington Campus; Loughborough United Kingdom
| | - Kelley M. Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station Texas
| | - Michael S. Tivers
- Bristol Veterinary School; University of Bristol, Langford House; Langford Bristol United Kingdom
| | - Donald A. Yool
- The Royal (Dick) School of Veterinary Studies, Easter Bush Campus; Midlothian Edinburgh United Kingdom
| | - Davina M. Anderson
- Anderson Moores Veterinary Specialists; Hursley Winchester United Kingdom
| | - Kathryn M. Pratschke
- North East Veterinary Referrals, Northumberland Business Park West; Cramlington Northumberland United Kingdom
- University of Glasgow School of Veterinary Medicine; Bearsden Glasgow United Kingdom
| | - Ines Gordo
- Pride Veterinary Centre; Derby Derbyshire United Kingdom
| | - Herve Brissot
- Pride Veterinary Centre; Derby Derbyshire United Kingdom
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College; University of Guelph; Guelph Ontario Canada
| | - Melanie Olive
- Centre Hospitalier Vétérinaire Atlantia; Nantes France
| | | | - Laura E. Selmic
- Department of Veterinary Clinical Sciences; The Ohio State University, 601 Vernon L Tharp St; Columbus OH 43210
| | - Barbara M. Kirby
- Section of Veterinary Clinical Sciences; University College Dublin; Belfield Dublin Ireland
| |
Collapse
|
26
|
Joffe MR, Hall E, Tan C, Brunel L. Evaluation of different methods of securing cellophane bands for portosystemic shunt attenuation. Vet Surg 2018; 48:42-49. [DOI: 10.1111/vsu.13125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/26/2018] [Accepted: 10/04/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Michelle Robyn Joffe
- Sydney School of Veterinary Science, Faculty of Science; University of Sydney; Sydney New South Wales Australia
| | - Evelyn Hall
- Sydney School of Veterinary Science, Faculty of Science; University of Sydney; Sydney New South Wales Australia
| | - Christopher Tan
- Sydney School of Veterinary Science, Faculty of Science; University of Sydney; Sydney New South Wales Australia
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School; University of New South Wales; Sydney New South Wales Australia
| | - Laurencie Brunel
- Sydney School of Veterinary Science, Faculty of Science; University of Sydney; Sydney New South Wales Australia
| |
Collapse
|
27
|
Bristow P, Lipscomb V, Kummeling A, Packer R, Gerrits H, Homan K, Ortiz V, Newson K, Tivers M. Health-related quality of life following surgical attenuation of congenital portosystemic shunts versus healthy controls. J Small Anim Pract 2018; 60:21-26. [PMID: 30251431 DOI: 10.1111/jsap.12927] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 08/09/2018] [Accepted: 08/13/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To design a health-related quality of life questionnaire for dogs with congenital portosystemic shunts, use it in a cohort of dogs treated with suture attenuation and compare results with those obtained from a healthy control cohort. MATERIALS AND METHODS Data were collected from the hospital records of dogs treated with suture ligation of an intrahepatic or extrahepatic congenital portosystemic shunt at two referral centres. Owners were asked to complete a questionnaire assessing their dog's health-related quality of life preoperatively (retrospectively) and at the time of follow-up. Owners of control dogs also completed the questionnaire. RESULTS One hundred and twenty-eight dogs with congenital portosystemic shunts and 131 control dogs were recruited. Median follow-up time was 64 months (range 19.7 to 157.2). The median long-term health-related quality of life score was excellent for both intrahepatic and extrahpatic shunt cases and similar to that of control dogs. The long-term portosystemic shunt clinical sign scores for both intrahepatic and extrahepatic congenital portosystemic shunt dogs were significantly worse than the those of the control group. CLINICAL SIGNIFICANCE Suture attenuation of congenitial portosystemic shunts is associated with an excellent health-related quality of life score at long-term follow-up.
Collapse
Affiliation(s)
- P Bristow
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
| | - V Lipscomb
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
| | - A Kummeling
- Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Utrecht University, Utrecht, 3508, The Netherlands
| | - R Packer
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
| | - H Gerrits
- Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Utrecht University, Utrecht, 3508, The Netherlands
| | - K Homan
- Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Utrecht University, Utrecht, 3508, The Netherlands
| | - V Ortiz
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
| | - K Newson
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
| | - M Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Herts, AL9 7TA, UK
| |
Collapse
|
28
|
Crowley J, Foo T, Boland L, Brunel L. Recanalisation of a congenital extrahepatic portosystemic shunt previously attenuated with cellophane banding in a cat. JFMS Open Rep 2018; 4:2055116918795717. [PMID: 30186617 PMCID: PMC6117867 DOI: 10.1177/2055116918795717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case summary A congenital extrahepatic portosystemic shunt was attenuated with commercial
roll cellophane banding in a cat and postoperative liver changes were
monitored using CT angiography (CTA). The patient clinically improved after
cellophane banding, characterised by resolution of hepatic encephalopathy,
weight gain, reference interval (RI) bile acid stimulation tests, as well as
CTA-documented increased liver size, increased hepatic vasculature and shunt
attenuation. Six months later the cat re-presented with recurrence of
clinical signs and increased bile acids. CTA confirmed recanalisation of the
shunt. Shunt attenuation was repeated using pure cellophane banding and
nearly complete closure of the shunt was later documented by CTA. Seven
months later, recanalisation was again documented via CTA and associated
with clinical signs and increased bile acids. Complete ligation of the shunt
was achieved using a polypropylene ligature and a titanium ligating clip. At
long-term follow-up, the cat was clinically well, and bile acids and
biochemistry were within the RIs. Relevance and novel information This is the first report of CTA-documented recanalisation of an extrahepatic
portosystemic shunt previously attenuated with cellophane banding.
Recanalisation should be considered as a differential for recurrence of
hepatic encephalopathy following cellophane banding.
Collapse
Affiliation(s)
- James Crowley
- University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Timothy Foo
- University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Lara Boland
- University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Laurencie Brunel
- University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| |
Collapse
|
29
|
Traverson M, Lussier B, Huneault L, Gatineau M. Comparative outcomes between ameroid ring constrictor and cellophane banding for treatment of single congenital extrahepatic portosystemic shunts in 49 dogs (1998-2012). Vet Surg 2017; 47:179-187. [DOI: 10.1111/vsu.12747] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 06/20/2017] [Accepted: 07/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marine Traverson
- Département de sciences cliniques; Centre Hospitalier Universitaire Vétérinaire, Faculté de Médecine Vétérinaire de l'Université de Montréal; Saint-Hyacinthe Quebec Canada
- Département de chirurgie; Centre Vétérinaire DMV; Lachine Quebec Canada
| | - Bertrand Lussier
- Département de sciences cliniques; Centre Hospitalier Universitaire Vétérinaire, Faculté de Médecine Vétérinaire de l'Université de Montréal; Saint-Hyacinthe Quebec Canada
| | - Louis Huneault
- Département de chirurgie; Centre Vétérinaire Rive-Sud; Brossard Quebec Canada
| | - Matthieu Gatineau
- Département de chirurgie; Centre Vétérinaire DMV; Lachine Quebec Canada
| |
Collapse
|
30
|
Losinski SL, Townsend KL, Kruzic JJ, Robertson BL, Sandwisch JMM, Milovancev M, Nemanic S. Computed tomographic imaging and mechanical analysis of cellophane banding secured with locking polymer clips for portosystemic shunts in canine cadavers. Am J Vet Res 2017; 78:1338-1346. [DOI: 10.2460/ajvr.78.11.1338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
31
|
Affiliation(s)
- J. R. Gold
- Department of Clinical Sciences; Washington State University; Pullman USA
| |
Collapse
|
32
|
Comparison of contrast-enhanced multidetector computed tomography angiography and splenoportography for the evaluation of portosystemic-shunt occlusion after cellophane banding in dogs. BMC Vet Res 2016; 12:283. [PMID: 27938359 PMCID: PMC5148836 DOI: 10.1186/s12917-016-0910-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/02/2016] [Indexed: 01/23/2023] Open
Abstract
Background Many patients with a congenital extrahepatic portosystemic shunt (PSS) do not tolerate an immediate shunt closure. Therefore, slow progressive techniques were developed. To evaluate the success of shunt closure diagnostic imaging is essential to identify possible residual blood flow through the shunt vessel. There is a lack of information about the reliability of computed tomography angiography (CTA) for evaluating residual flow through a PSS after treatment. The purpose of this prospective study was to compare the results of CTA with splenoportography. Three months after cellophane banding CTA and splenoportography were performed in 20 dogs and reviewed by three independent examiners, respectively. In both imaging modalities the presences of a residual shunt was judged as present or absent and the extent of visibility of portal vasculature was recorded. Results Based on the evaluation of the splenoportography residual flow through shunt was present in 6 dogs. The classification of residual shunt present or absent showed a substantial to perfect agreement (κ = 0.65–1.00) between the observers in splenoportography and a slight to moderate agreement (κ = 0.11–0.51) for CTA. Sensitivity and specificity varied between 0.50 and 1.00 and 0.57–0.85, respectively. Significant correlation between CTA and splenoportography for the classification of residual shunt was present only in one observer but not in the other two. Conclusion More studies were classified as residual shunt positive with CTA compared to splenoportography. It remains unclear which methods do reflect reality better and thus which method is superior. The greater inter-rater agreement for splenoportography suggests a greater reliability of this technique.
Collapse
|
33
|
Wallace ML, Ellison GW, Batich C, Case JB, Kim SE. In vitro development and evaluation of a polyacrylic acid-silicone device intended for gradual occlusion of portosystemic shunts in dogs and cats. Am J Vet Res 2016; 77:315-22. [PMID: 26919604 DOI: 10.2460/ajvr.77.3.315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop a device intended for gradual venous occlusion over 4 to 6 weeks. SAMPLE Silicone tubing filled with various inorganic salt and polyacrylic acid (PAA) formulations and mounted within a polypropylene or polyether ether ketone (PEEK) outer ring. PROCEDURES 15 polypropylene prototype rings were initially filled with 1 of 5 formulations and placed in PBSS. In a second test, 10 polypropylene and 7 PEEK prototype rings were filled with 1 formulation and placed in PBSS. In a third test, 2 formulations were loaded into 6 PEEK rings each, placed in physiologic solution, and incubated. In all tests, ring luminal diameter, outer diameter, and luminal area were measured over 6 weeks. RESULTS In the first test, 2 formulations had the greatest changes in luminal area and diameter, and 1 of those had a greater linear swell rate than the other had. In the second test, 6 of 7 PEEK rings and 6 of 10 polypropylene rings closed to a luminal diamater < 1 mm within 6 weeks. Polypropylene rings had a greater increase in outer diameter than did PEEK rings between 4.5 and 6 weeks. In the third test, 11 of 12 PEEK rings gradually closed to a luminal diameter < 1 mm within 6 weeks. CONCLUSIONS AND CLINICAL RELEVANCE A PAA and inorganic salt formulation in a prototype silicone and polymer ring resulted in gradual occlusion over 4 to 6 weeks in vitro. Prototype PEEK rings provided more reliable closure than did polypropylene rings.
Collapse
|
34
|
Greenhalgh SN, Reeve JA, Johnstone T, Goodfellow MR, Dunning MD, O'Neill EJ, Hall EJ, Watson PJ, Jeffery ND. Long-term survival and quality of life in dogs with clinical signs associated with a congenital portosystemic shunt after surgical or medical treatment. J Am Vet Med Assoc 2015; 245:527-33. [PMID: 25148094 DOI: 10.2460/javma.245.5.527] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare long-term survival and quality of life data in dogs with clinical signs associated with a congenital portosystemic shunt (CPSS) that underwent medical or surgical treatment. DESIGN Prospective cohort study. ANIMALS 124 client-owned dogs with CPSS. PROCEDURES Dogs received medical or surgical treatment without regard to signalment, clinical signs, or clinicopathologic results. Survival data were analyzed with a Cox regression model. Quality of life information, obtained from owner questionnaires, included frequency of CPSS-associated clinical signs (from which a clinical score was derived), whether owners considered their dog normal, and (for surgically treated dogs) any ongoing medical treatment for CPSS. A Mann-Whitney U test was used to compare mean clinical score data between surgically and medically managed dogs during predetermined follow-up intervals. RESULTS 97 dogs underwent surgical treatment; 27 were managed medically. Median follow-up time for all dogs was 1,936 days. Forty-five dogs (24 medically managed and 21 surgically managed) died or were euthanized during the follow-up period. Survival rate was significantly improved in dogs that underwent surgical treatment (hazard ratio, 8.11; 95% CI, 4.20 to 15.66) than in those treated medically for CPSS. Neither age at diagnosis nor shunt type affected survival rate. Frequency of clinical signs was lower in surgically versus medically managed dogs for all follow-up intervals, with a significant difference between groups at 4 to 7 years after study entry. CONCLUSIONS AND CLINICAL RELEVANCE Surgical treatment of CPSS in dogs resulted in significantly improved survival rate and lower frequency of ongoing clinical signs, compared with medical management. Age at diagnosis did not affect survival rate and should not influence treatment choice.
Collapse
Affiliation(s)
- Stephen N Greenhalgh
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, England
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Smith RR, Hunt GB, Garcia-Nolen TC, Stump S, Stover SM. Spectroscopic and Mechanical Evaluation of Thin Film Commonly Used for Banding Congenital Portosystemic Shunts in Dogs. Vet Surg 2013; 42:478-87. [DOI: 10.1111/j.1532-950x.2013.12010.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 02/01/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Rebecca R. Smith
- Department of Surgical and Radiological Sciences; University of California-Davis; Davis; CA
| | - Geraldine B. Hunt
- Department of Surgical and Radiological Sciences; University of California-Davis; Davis; CA
| | - Tanya C. Garcia-Nolen
- J.D. Wheat Veterinary Orthopedic Research Laboratory; University of California-Davis; Davis; CA
| | - Samuel Stump
- California Animal Health & Food Safety Laboratory System; University of California-Davis; Davis; CA
| | - Susan M. Stover
- J.D. Wheat Veterinary Orthopedic Research Laboratory; University of California-Davis; Davis; CA
| |
Collapse
|
36
|
Liver. CANINE AND FELINE GASTROENTEROLOGY 2013. [PMCID: PMC7161409 DOI: 10.1016/b978-1-4160-3661-6.00061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
37
|
Kavanagh C, Shaw S, Webster CRL. Coagulation in hepatobiliary disease. J Vet Emerg Crit Care (San Antonio) 2012; 21:589-604. [PMID: 22316251 DOI: 10.1111/j.1476-4431.2011.00691.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the pathogenesis and clinical consequences of coagulation abnormalities accompanying hepatobiliary disorders and to highlight the need for further studies to characterize these derangements and their treatment options in small animal patients. DATA SOURCES Veterinary and human medical literature: original research articles, scientific reviews, consensus statements, and recent texts. SUMMARY The liver plays an important role in the production and clearance of many components of coagulation. A wide range of hemostatic derangements can occur in patients with hepatobiliary disease including alterations in platelet number and function, coagulation factor levels, anticoagulants, vascular endothelial function, and fibrinolysis. As these hemostatic alterations include both pro- and anticoagulation pathways, the net result is often a rebalanced hemostatic system that can be easily disrupted by concurrent conditions resulting in either clinical bleeding or thrombosis. Conventional coagulation tests are inadequate at identifying the spectrum of coagulation alterations occurring in patients with hepatobiliary disease, but their evaluation is necessary to assess bleeding risk and provide prognostic information. A paucity of information exists regarding the treatment of the coagulation derangements in small animals with hepatobiliary disease. Extrapolation from human studies provides some information about potential treatment options, but further studies are warranted in this area to elucidate the best management for coagulation abnormalities in dogs and cats with hepatobiliary disease. CONCLUSION Hepatobiliary disease can have profound effects on coagulation function leading to hypercoagulable or hypocoagulable states. Overall coagulation status with hepatobiliary disease depends on both the type and severity of disease and the presence of associated complications.
Collapse
Affiliation(s)
- Carrie Kavanagh
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, USA
| | | | | |
Collapse
|
38
|
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
| | | | | |
Collapse
|
39
|
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.
Collapse
Affiliation(s)
- M S Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, United Kingdom
| | | | | | | | | |
Collapse
|
40
|
Greenhalgh SN, Dunning MD, McKinley TJ, Goodfellow MR, Kelman KR, Freitag T, O'Neill EJ, Hall EJ, Watson PJ, Jeffery ND. Comparison of survival after surgical or medical treatment in dogs with a congenital portosystemic shunt. J Am Vet Med Assoc 2010; 236:1215-20. [PMID: 20513200 DOI: 10.2460/javma.236.11.1215] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare survival of dogs with a congenital portosystemic shunt (CPSS) that received medical or surgical treatment. DESIGN Prospective cohort study. ANIMALS 126 client-owned dogs with a single CPSS. PROCEDURES Dogs were examined at 1 of 3 referral clinics, and a single CPSS was diagnosed in each. Dogs received medical or surgical treatment without regard to signalment, clinical signs, or results of hematologic or biochemical analysis. Survival data were analyzed via a Cox regression model. RESULTS During a median follow-up period of 579 days, 18 of 126 dogs died as a result of CPSS. Dogs treated via surgical intervention survived significantly longer than did those treated medically. Hazard ratio for medical versus surgical treatment of CPSS (for the treatment-only model) was 2.9 (95% confidence interval, 1.1 to 7.2). Age at CPSS diagnosis did not affect survival. CONCLUSIONS AND CLINICAL RELEVANCE Both medical and surgical treatment can be used to achieve long-term survival of dogs with CPSS, although results of statistical analysis supported the widely held belief that surgery is preferable to medical treatment. However, the study population consisted of dogs at referral clinics, which suggested that efficacy of medical treatment may have been underestimated. Although surgical intervention was associated with a better chance of long-term survival, medical management provided an acceptable first-line option. Age at examination did not affect survival, which implied that early surgical intervention was not essential. Dogs with CPSS that do not achieve acceptable resolution with medical treatment can subsequently be treated surgically.
Collapse
Affiliation(s)
- Stephen N Greenhalgh
- Department of Veterinary Medicine, Veterinary School, University of Cambridge, Cambridge, CB3 0ES, England
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
McALINDEN AIDANB, BUCKLEY CONORT, KIRBY BARBARAM. Biomechanical Evaluation of Different Numbers, Sizes and Placement Configurations of Ligaclips Required to Secure Cellophane Bands. Vet Surg 2010; 39:59-64. [DOI: 10.1111/j.1532-950x.2009.00603.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
42
|
Landon BP, Abraham LA, Charles JA. Use of transcolonic portal scintigraphy to evaluate efficacy of cellophane banding of congenital extrahepatic portosystemic shunts in 16 dogs. Aust Vet J 2008; 86:169-79; quiz CE1. [DOI: 10.1111/j.1751-0813.2008.00278.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
43
|
Bussadori R, Bussadori C, Millán L, Costilla S, Rodríguez-Altónaga JA, Orden MA, Gonzalo-Orden JM. Transvenous coil embolisation for the treatment of single congenital portosystemic shunts in six dogs. Vet J 2008; 176:221-6. [PMID: 17466545 DOI: 10.1016/j.tvjl.2007.02.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Revised: 02/14/2007] [Accepted: 02/24/2007] [Indexed: 11/28/2022]
Abstract
This article describes the treatment of single congenital portosystemic shunts (CPSs) (intrahepatic and extrahepatic) using an interventional radiology technique involving embolisation of anomalous vessels with percutaneous coils. Briefly, a multipurpose catheter was introduced into the caudal vena cava and then into the portosystemic shunt. An autoexpandable stent was placed in the caudal vena cava, next to the shunt, in order to avoid coil migrations, and a cobra-like vascular catheter was used to pass through the stent and to place the coils in the shunt. This technique was used for treatment of CPS in six dogs. The results indicate that percutaneous embolisation of a CPS using coils, a less invasive technique than the traditional surgical technique, may result in complete closure of the anomalous vessel without development of portal hypertension.
Collapse
Affiliation(s)
- Roberto Bussadori
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of León, 24071 León, Spain
| | | | | | | | | | | | | |
Collapse
|
44
|
Worley DR, Holt DE. Clinical outcome of congenital extrahepatic portosystemic shunt attenuation in dogs aged five years and older: 17 cases (1992–2005). J Am Vet Med Assoc 2008; 232:722-7. [DOI: 10.2460/javma.232.5.722] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
45
|
Abstract
The diagnostic investigation of portosystemic shunts (PSS) has evolved over the last few decades, helping to understand and identify these vascular anomalies that affect many dogs and cats. Ultrasonography has become an important tool in small animals and high-resolution systems are now widely available. Several sonographic features are observed with the different types of congenital and acquired PSS. A systematic, stepwise approach is described to facilitate ultrasound diagnosis of PSS in small animals.
Collapse
Affiliation(s)
- Marc-André D'Anjou
- Department of Clinical Sciences, Faculté de Medecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada.
| |
Collapse
|
46
|
Frankel D, Seim H, MacPhail C, Monnet E. Evaluation of cellophane banding with and without intraoperative attenuation for treatment of congenital extrahepatic portosystemic shunts in dogs. J Am Vet Med Assoc 2006; 228:1355-60. [PMID: 16649938 DOI: 10.2460/javma.228.9.1355] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of intraoperative attenuation of congenital extrahepatic portosystemic shunts (CEPSSs) during cellophane banding procedures in dogs. STUDY DESIGN Retrospective case series and prospective study. ANIMALS 18 cases evaluated retrospectively and 14 dogs evaluated prospectively. PROCEDURES Gradual occlusion of CEPSSs was performed via cellophane banding. Shunts were occluded to a diameter < 3.0 mm during surgery in dogs prospectively enrolled in the partial attenuation group, whereas the shunt was not attenuated during surgery in dogs prospectively enrolled in the no-attenuation group or in dogs that had previously undergone surgery and were retrospectively evaluated. Postprandial serum bile acids (PPSBA) concentrations were measured before surgery and at various time points after surgery. RESULTS Mean +/- SD PPSBA concentrations were 26.8 +/- 24.5 micromol/L at < 2.25 months after surgery (n = 16 dogs), 22.1 +/- 14.0 micromol/L from 2.25 to 6 months after surgery (12 dogs), and 34.9 +/- 32.5 micromol/L at > 6 months after surgery (22 dogs). In the prospectively enrolled dogs, mean PPSBA concentrations increased over time in dogs in the partial attenuation group, but not in dogs in the no-attenuation group. CONCLUSIONS AND CLINICAL RELEVANCE Cellophane banding may be used to occlude larger CEPSSs and may decrease the need for intraoperative monitoring of portal vein blood pressure. The technique may facilitate minimally invasive treatment of CEPSSs in dogs. Intraoperative attenuation of CEPSSs to a diameter < 3.0 mm is not necessary and may result in a less favorable outcome.
Collapse
Affiliation(s)
- Daniel Frankel
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft Collins, CO 80525, USA
| | | | | | | |
Collapse
|
47
|
Abstract
Laparoscopic portosystemic shunt attenuation was successfully performed in two dogs. Aberrant vessels were noted on visual examination of the abdominal vasculature. Cellophane bands were placed around the vessel laparoscopically for attenuation. The dogs had minimal postoperative morbidity, and there was biochemical evidence of adequate shunt ligation at follow-up examination.
Collapse
Affiliation(s)
- Jonathan M Miller
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | | |
Collapse
|
48
|
MacPhail CM, Monnet E, Gaynor JS. Evaluation of splanchnic oxygen extraction ratio as an index of portal vein pressure in dogs. Am J Vet Res 2005; 63:15-8. [PMID: 16206774 DOI: 10.2460/ajvr.2002.63.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine changes in splanchnic oxygen extraction ratio during experimentally induced portal hypertension in dogs. ANIMALS 6 clinically normal dogs. PROCEDURE Standard midline laparotomy and median sternotomy were performed in anesthetized dogs. Baseline measurements of arterial blood pressure, aortic blood flow, portal vein blood flow, and portal vein pressure were acquired, and arterial, venous, and portal vein blood samples were obtained to determine systemic and splanchnic oxygen extraction ratios. The portal vein was gradually occluded until a pressure of 18 cm of H2O was reached; this pressure was maintained for 30 minutes, and measurements and collection of blood samples were repeated. RESULTS Portal vein blood flow decreased significantly from 457 +/- 136 ml/min before to 266 +/- 83 ml/min after induction of portal hypertension. Oxygen content in the portal vein significantly decreased from 12.3 +/- 1.85 to 8.2 +/- 2.31%, and splanchnic oxygen extraction ratio significantly increased from 15.8 +/- 6.2 to 37.4 +/- 10.9% during portal hypertension. There was a significant inverse correlation between portal vein blood flow and splanchnic oxygen extraction ratio at baseline and during portal hypertension. CONCLUSIONS AND CLINICAL RELEVANCE An increase in splanchnic oxygen extraction ratio is evident with partial attenuation of the portal vein and the concurrent decrease in portal vein blood flow. Correlation of oxygen extraction ratio with portal vein blood flow may be a more important indicator for determination of an endpoint to prevent congestion and ischemia of the gastrointestinal tract and pancreas during ligation of portosystemic shunts.
Collapse
Affiliation(s)
- Catriona M MacPhail
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523-1620, USA
| | | | | |
Collapse
|
49
|
Sun F, Usón J, Crisóstomo V, Maynar M. Interventional cardiovascular techniques in small animal practice--embolotherapy and chemoembolization. J Am Vet Med Assoc 2005; 227:402-9. [PMID: 16121606 DOI: 10.2460/javma.2005.227.402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Fei Sun
- Endoluminal Therapy and Diagnosis Department, Minimally Invasive Surgery Centre, Cáceres, Spain
| | | | | | | |
Collapse
|
50
|
Monnet E, Rosenberg A. Effect of protein concentration on rate of closure of ameroid constrictors in vitro. Am J Vet Res 2005; 66:1337-40. [PMID: 16173475 DOI: 10.2460/ajvr.2005.66.1337] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of protein concentration on rate of closure of ameroid constrictors in vitro. SAMPLE POPULATION Twenty-four 3.5-mm ameroid constrictors. PROCEDURE Ameroid constrictors were equally allocated into 4 treatment groups; constrictors were placed in saline (0.9% NaCl) solution (control) or plasma diluted with saline solution to obtain protein concentrations of 1.5, 3, or 6 g/dL. Ameroid constrictors were incubated for 27 days. A digital camera was used to image ameroid constrictors in culture at 1, 6, 11, 16, 21, and 27 days, and the lumen diameter of each constrictor was measured. RESULTS None of the rings were completely closed at 27 days. Mean final lumen diameter was 0.205 +/- 0.22 mm. Mean final lumen diameter of constrictors in the control group was significantly larger than that of constrictors in the 1.5, 3, and 6 g/dL groups. Constrictors in the 1.5 g/dL group closed to a larger diameter than that of constrictors in the 6 g/dL group. Constrictors in the control group had the smallest overall change in lumen diameter, compared with constrictors in the 3 and 6 g/dL groups. Constrictors in the 1.5 g/dL group had a significant decrease in overall lumen diameter, compared with constrictors in the 3 and 6 g/dL groups. The diameter of the ameroid lumen was a function of time and protein concentration. CONCLUSIONS AND CLINICAL RELEVANCE High plasma protein concentrations resulted in rapid closure of the ameroid constrictor lumen. Complete closure of ameroid constrictors may not be attributable to imbibition of casein.
Collapse
Affiliation(s)
- Eric Monnet
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | | |
Collapse
|