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Ishigaki K, Asano K, Tamura K, Sakurai N, Terai K, Heishima T, Yoshida O. Percutaneous transvenous coil embolization (PTCE) for treatment of single extrahepatic portosystemic shunt in dogs. BMC Vet Res 2023; 19:215. [PMID: 37858152 PMCID: PMC10585740 DOI: 10.1186/s12917-023-03783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND There is limited information regarding percutaneous transvenous coil embolization (PTCE) for single extrahepatic portosystemic shunt (PSS). This study aimed to describe the procedure and outcome of PTCE in dogs with a single extrahepatic PSS. Forty-two privately owned dogs were included in this study. All dogs were diagnosed with extrahepatic PSS by computed tomography (CT). Preoperative CT images were used to evaluate the diameter of the PSS for coil placement. A multipurpose balloon catheter was percutaneously inserted into the PSS via the jugular vein, and transvenous retrograde portography (TRP) and measurement of blood pressure in the PSS (pPSS) were performed during balloon inflation; one or more embolization coils were implanted via the catheter. RESULTS In most cases, preoperative median fasting and postprandial serum total bile acid (TBA) concentrations were high (fasting, 86.5 μmol/L [ 3.7-250.0 μmol/L]; postprandial, 165.5 μmol/L [ 1.5-565.0 μmol/L]). CT revealed that 30 dogs had left gastrophrenic shunt; eight had left gastroazygos shunt; and one each had left gastrocaval, splenocaval, splenophrenic, and left colocaval shunt. TRP revealed that intrahepatic portal vascularity was clearly detectable in all dogs. The median values of pPSS before and during the balloon occlusion were 4.8 mmHg [2.0-13.0 mmHg] and 8.6 mmHg [5.0-18.0 mmHg], respectively. The median number and diameter of coils used were 2 coils [1 - 5 coils] and 8.0 mm [4.0 - 12.0 mm], respectively. The median times of irradiation and PTCE were 9 min [4-26 min] and 40 min [23-75 min], respectively. The median fasting and postprandial TBAs significantly decreased to 8.2 μmol/L [0.3-45.1 μmol/L, n = 38, p = 0.0028] and 19.8 μmol/L [0.3-106.7 μmol/L, n = 38, p = 0.0018], respectively, approximately 1 month after PTCE. The clinical success rate of PTCE without requirement for a second surgery was 95.2% (40/42 dogs). During revision surgery, one dog underwent surgical ligation and, in another dog, an ameroid constrictor was placed. CONCLUSIONS PTCE was clinically effective in treating single extrahepatic PSS in dogs. Preoperative CT and TRP prior to PTCE might be clinically valuable for choosing the size of embolization coils, deciding the appropriate location of coil implantation, and estimating the number of coils to be implanted. PTCE is a promising alternative to conventional surgical procedures for single extrahepatic PSS in dogs.
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Affiliation(s)
- Kumiko Ishigaki
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Kazushi Asano
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan.
| | - Kei Tamura
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Naoki Sakurai
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Kazuyuki Terai
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Tatsuya Heishima
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Orie Yoshida
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
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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.
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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
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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.
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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
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Konstantinidis AO, Adamama-Moraitou KK, Patsikas MN, Papazoglou LG. Congenital Portosystemic Shunts in Dogs and Cats: Treatment, Complications and Prognosis. Vet Sci 2023; 10:vetsci10050346. [PMID: 37235429 DOI: 10.3390/vetsci10050346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Congenital portosystemic shunts (CPSS) are a common vascular anomaly of the liver in dogs and cats. Clinical signs of CPSS are non-specific and may wax and wane, while laboratory findings can raise the clinical suspicion for CPSS, but they are also not specific. Definitive diagnosis will be established by evaluation of liver function tests and diagnostic imaging. The aim of this article is to review the management, both medical and surgical, complications, and prognosis of CPSS in dogs and cats. Attenuation of the CPSS is the treatment of choice and may be performed by open surgical intervention using ameroid ring constrictors, thin film banding, and partial or complete suture ligation or by percutaneous transvenous coil embolization. There is no strong evidence to recommend one surgical technique over another. Medical treatment strategies include administration of non-absorbable disaccharides (i.e., lactulose), antibiotics, and dietary changes, and are indicated for pre-surgical stabilization or when surgical intervention is not feasible. After CPSS attenuation, short- and long-term post-surgical complications may be seen, such as post-operative seizures and recurrence of clinical signs, respectively. Prognosis after surgical attenuation of CPSS is generally favorable for dogs and fair for cats.
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Affiliation(s)
- Alexandros O Konstantinidis
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Katerina K Adamama-Moraitou
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Michail N Patsikas
- Laboratory of Diagnostic Imaging, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Lysimachos G Papazoglou
- Companion Animal Clinic (Surgery and Obstetrics Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
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Filipas M, Riggs J, Self I. Intraoperative management of acute portal hypertension during liver lobectomy in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Malina Filipas
- Department of Veterinary Medicine University of Cambridge Cambridge UK
| | - Julia Riggs
- Department of Veterinary Medicine University of Cambridge Cambridge UK
| | - Ian Self
- Department of Veterinary Medicine University of Cambridge Cambridge UK
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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.
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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
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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.
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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
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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
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Strickland R, Tivers MS, Fowkes RC, Lipscomb VJ. Incidence and risk factors for neurological signs after attenuation of a single congenital portosystemic shunt in 50 cats. Vet Surg 2020; 50:303-311. [PMID: 32691934 DOI: 10.1111/vsu.13489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/07/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the incidence, outcome, and risk factors for postattenuation neurological signs (PANS) in cats treated for single congenital portosystemic shunts (CPSS). STUDY DESIGN Retrospective cohort study. ANIMALS Cats (n = 50) with a single CPSS. METHODS Medical records of cats treated by surgical attenuation of a single CPSS between 2003 and 2017 were reviewed for signalment, surgical technique, preoperative management and postoperative clinical outcomes. Binary logistic regression was performed to investigate risk factors for occurrence of PANS and seizures. RESULTS Congenital portosystemic shunts in 50 cats included 40 extrahepatic and 10 intrahepatic shunts. Postattenuation neurological signs were recorded in 31 (62%) cats and graded as 1 in 10 cats, 2 in nine cats, and 3 in 12 cats. Postattenuation neurological signs included seizures in 11 cats. Five of 31 cats with PANS did not survive to discharge. No association was detected between PANS or seizures and the type of CPSS (intrahepatic or extrahepatic), degree of attenuation, age, or the use of perioperative levetiracetam or hepatic encephalopathy immediately preoperatively. Osmolality at a median 24 hours postoperatively was lower in cats with PANS (P < .049, Wald 3.867, odds ratio [Exp(B)] 0.855, CI 0.732-0.999). CONCLUSION Postattenuation neurological signs are common complications in cats treated for CPSS. Preoperative levetiracetam did not prevent the occurrence of PANS or seizures. The only risk factor for PANS detected was lower postoperative Osmolality in cats with PANS at 24 hours. CLINICAL SIGNIFICANCE Postattenuation neurological signs including seizures occur frequently in cats undergoing surgical attenuation of a CPSS. Preoperative levetiracetam did not protect against the development of PANS.
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Affiliation(s)
- Rhiannon Strickland
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
| | - Michael S Tivers
- Paragon Veterinary Referrals, Red Hall Crescent, Wakefield, United Kingdom
| | - Robert C Fowkes
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, United Kingdom
| | - Victoria J Lipscomb
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, United Kingdom
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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.
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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
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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: 10] [Impact Index Per Article: 2.0] [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.
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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
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Matiasovic M, Chanoit GPA, Meakin LB, Tivers MS. Outcomes of dogs treated for extrahepatic congenital portosystemic shunts with thin film banding or ameroid ring constrictor. Vet Surg 2019; 49:160-171. [PMID: 31270829 DOI: 10.1111/vsu.13273] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 05/12/2019] [Accepted: 06/02/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To compare the outcomes of dogs treated at a single institution for single extrahepatic congenital portosystemic shunts (CPSS) by thin film banding (TFB) or by placement of an ameroid constrictor (AC). STUDY DESIGN Retrospective case series. ANIMALS Seventy-six client-owned dogs with CPSS treated with TFB (n = 53) or AC (n = 23). METHODS Records were reviewed for signalment, preoperative, intraoperative, and postoperative management and short-term outcomes. Data on second surgeries were reviewed. Long-term outcomes were obtained via an owner-directed health-related quality of life questionnaire. The rates of complications, mortality, and revision surgery were compared between the treatment groups. RESULTS Postoperative complications occurred in 15 (28%) dogs with TFB (9% mortality, n = 5) and 8 (35%) dogs with an AC (4% mortality, n = 1). Long-term follow-up was available in 41 of 56 dogs at a median of 55 months (range, 15-89). Revision surgery for persistent shunting was performed in 14 (29%) dogs treated initially with TFB and in no dogs treated initially with AC (P = .007). Median long-term outcome scores were good in both groups; nine of 14 revision surgeries led to favorable outcomes. CONCLUSION Persistent shunting requiring revision surgery was more common when CPSS were treated with TFB than with an AC, but both treatments achieved favorable long-term outcomes. CLINICAL SIGNIFICANCE Treatment of CPPS by placement of an AC rather than TFB seems more reliable for shunt attenuation and prevention of revision surgeries.
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Affiliation(s)
- Matt Matiasovic
- Bristol Veterinary School, University of Bristol, Langford, United Kingdom
| | | | - Lee B Meakin
- Bristol Veterinary School, University of Bristol, Langford, United Kingdom
| | - Mickey S Tivers
- Bristol Veterinary School, University of Bristol, Langford, United Kingdom
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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
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Strickland R, Tivers MS, Adamantos SE, Harcourt-Brown TR, Fowkes RC, Lipscomb VJ. Incidence and risk factors for neurological signs after attenuation of single congenital portosystemic shunts in 253 dogs. Vet Surg 2018; 47:745-755. [DOI: 10.1111/vsu.12925] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 01/10/2018] [Accepted: 03/02/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Rhiannon Strickland
- Department of Clinical Science and Services; Royal Veterinary College, University of London; London United Kingdom
| | - Michael S. Tivers
- School of Veterinary Sciences; University of Bristol; Bristol United Kingdom
| | | | | | - Robert C. Fowkes
- Department of Comparative Biomedical Sciences; Royal Veterinary College, University of London; London United Kingdom
| | - Victoria J. Lipscomb
- Department of Clinical Science and Services; Royal Veterinary College, University of London; London United Kingdom
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Culp WTN, Zwingenberger AL, Giuffrida MA, Wisner ER, Hunt GB, Steffey MA, Mayhew PD, Marks SL. Prospective evaluation of outcome of dogs with intrahepatic portosystemic shunts treated via percutaneous transvenous coil embolization. Vet Surg 2017; 47:74-85. [PMID: 29064581 DOI: 10.1111/vsu.12732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 05/04/2017] [Accepted: 06/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report outcome and complications after percutaneous transvenous coil embolization (PTCE) and evaluate the clinical, laboratory, and imaging changes in dogs with intrahepatic portosystemic shunts (IHPSS) pre-PTCE and post-PTCE. STUDY DESIGN Prospective clinical trial. ANIMALS Twenty-five dogs (15 dogs in imaging subgroup) with IHPSS. METHODS Clinical signs, hematologic, and biochemical parameters were recorded before and 3 months after PTCE. All dogs received the same medical treatment and underwent PTCE. In the imaging subgroup, ultrasonography, hepatic portal scintigraphy, and computed tomography-angiography were performed pre-PTCE and post-PTCE. RESULTS All evaluated bloodwork values improved by at least 50% of their initial value, by 3 months post-PTCE. Liver volume increased after PTCE (P = .001), but remained lower than normal in 11/15 dogs. Hepatic arterial fraction decreased after PTCE (P = .029), consistent with increased portal blood flow to the liver. Twenty-four of 25 dogs were available for reevaluation at 3 months, and all abnormal clinical signs had resolved in 22/24 dogs. CONCLUSION PTCE appears promising as a treatment for IHPSS, as clinical signs resolved in most cases, bloodwork abnormalities often normalized, and the procedure was performed safely with minimal complications. PTCE increased hepatic portal perfusion and liver volume in most dogs. These promising results justify a future randomized clinical trial comparing PTCE, other attenuation options, and medical management alone.
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Affiliation(s)
- William T N Culp
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Allison L Zwingenberger
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Michelle A Giuffrida
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Erik R Wisner
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Geraldine B Hunt
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Michele A Steffey
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Stanley L Marks
- Department of Medicine and Epidemiology, University of California-Davis, School of Veterinary Medicine, Davis, California
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Affiliation(s)
- J. R. Gold
- Department of Clinical Sciences; Washington State University; Pullman USA
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17
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Heidenreich DC, Giordano P, Kirby BM. Successful treatment of refractory seizures with phenobarbital, propofol, and medetomidine following congenital portosystemic shunt ligation in a dog. J Vet Emerg Crit Care (San Antonio) 2015; 26:831-836. [DOI: 10.1111/vec.12431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 06/18/2014] [Accepted: 08/29/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Dorothee C. Heidenreich
- Section of Veterinary Clinical Studies; School of Agriculture, Food Science, and Veterinary Medicine; University College Dublin Dublin Ireland
| | - Paola Giordano
- Section of Veterinary Clinical Studies; School of Agriculture, Food Science, and Veterinary Medicine; University College Dublin Dublin Ireland
| | - Barbara M. Kirby
- Section of Veterinary Clinical Studies; School of Agriculture, Food Science, and Veterinary Medicine; University College Dublin Dublin Ireland
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18
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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: 45] [Impact Index Per Article: 5.0] [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.
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Affiliation(s)
- Stephen N Greenhalgh
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, England
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19
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Falls EL, Milovancev M, Hunt GB, Daniel L, Mehl ML, Schmiedt CW. Long-term outcome after surgical ameroid ring constrictor placement for treatment of single extrahepatic portosystemic shunts in dogs. Vet Surg 2013; 42:951-7. [DOI: 10.1111/j.1532-950x.2013.12072.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 11/01/2012] [Indexed: 12/22/2022]
Affiliation(s)
- Emily L. Falls
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; University of Georgia; Athena Georgia
| | - Milan Milovancev
- Department of Clinical Sciences, College of Veterinary Medicine; Oregon State University; Corvallis Oregon
| | - Geraldine B. Hunt
- Department of Veterinary Surgical and Radiological Sciences; University of California; Davis California
| | - Leticia Daniel
- Department of Veterinary Surgical and Radiological Sciences; University of California; Davis California
| | - Margo L. Mehl
- VCA-San Francisco Veterinary Specialists; San Francisco California
| | - Chad W. Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine; University of Georgia; Athena Georgia
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20
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Nanfelt MR, Marolf AJ, Powers BE, Monnet E. Use of a Dacron shape-memory intravascular coil to achieve slow, progressive occlusion of the jugular vein in dogs. Vet Surg 2012; 40:853-60. [PMID: 22380668 DOI: 10.1111/j.1532-950x.2011.00872.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the ability of shape memory Dacron polymer vascular coils to induce the complete, gradual occlusion of the canine jugular vein. STUDY DESIGN Observational pilot study. ANIMALS Nine purpose-bred dogs. METHODS Eighteen coils were deployed in nine dogs using fluoroscopic-guided percutaneous transvenous coil implantation. Individual coil formulations varied around a Dacron polymer base. Jugular vein diameter, percent vessel occlusion, and thrombus echogenicity were monitored at weekly intervals using ultrasonography. Affected jugular veins were harvested at 6 weeks post-implantation and histopathological analysis was performed to assess adventitial fibrosis, intimal layer thickening, and inflammation. RESULTS Ten coils migrated from the jugular veins to the pulmonary vasculature within 0-2 weeks following implantation. Three jugular veins achieved at least 90% occlusion at six weeks. Histopathology of these jugular veins revealed marked perivascular thickening and fibrovascular proliferation, increased infiltration of macrophages, neutrophils and lymphocytes, and abundant fibroplasia. CONCLUSIONS Complete, gradual occlusion of a jugular vein was achieved in three dogs. Significant vessel wall reaction and inflammation can induce gradual vessel occlusion when a Dacron coil remains implanted within the jugular vein. Dacron polymer coils could be a feasible treatment option for the gradual occlusion of congenital portosystemic shunts in dogs using minimally invasive, percutaneous transvenous implantation.
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Affiliation(s)
- Michelle R Nanfelt
- James L. Voss Veterinary Medical Center and the Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA
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Tivers MS, Upjohn MM, House AK, Brockman DJ, Lipscomb VJ. Treatment of extrahepatic congenital portosystemic shunts in dogs - what is the evidence base? J Small Anim Pract 2011; 53:3-11. [PMID: 22098116 DOI: 10.1111/j.1748-5827.2011.01144.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A variety of surgical treatments and medical therapies are recommended for dogs with extrahepatic congenital portosystemic shunts (CPSS). The objective of this review was to assess the evidence base for the management of extrahepatic CPSS in dogs. An online bibliographic search was performed in November 2010 to identify articles relating to the question "Which of the treatment options for extrahepatic CPSS in dogs offers the best short- and long-term outcomes?" Articles were assigned a level of evidence based on a modified grading system. Thirty-eight articles were included in the review. Thirty-six articles were classified as grade 4 and two as grade 5. The timings and methods of assessment of short- and long-term outcomes varied widely between studies. One prospective study (grade 4a) showed that surgically treated dogs survived significantly longer than medically treated dogs. Four retrospective studies (grade 4b) compared the outcome of two surgical techniques but there were no statistically significant differences between treatment groups in terms of complications or outcome. The review found that the evidence base for the treatment of extrahepatic CPSS is weak. There is a lack of evidence of short- and long-term outcomes to recommend one treatment over another.
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Affiliation(s)
- M S Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, United Kingdom
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Fryer K, Levine J, Peycke L, Thompson J, Cohen N. Incidence of Postoperative Seizures with and without Levetiracetam Pretreatment in Dogs Undergoing Portosystemic Shunt Attenuation. J Vet Intern Med 2011; 25:1379-84. [DOI: 10.1111/j.1939-1676.2011.00819.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 08/12/2011] [Accepted: 09/01/2011] [Indexed: 11/29/2022] Open
Affiliation(s)
- K.J. Fryer
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station; TX
| | - J.M. Levine
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station; TX
| | - L.E. Peycke
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station; TX
| | - J.A. Thompson
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station; TX
| | - N.D. Cohen
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station; TX
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Tivers M, Lipscomb V. Congenital portosystemic shunts in cats: surgical management and prognosis. J Feline Med Surg 2011; 13:185-94. [PMID: 21338943 DOI: 10.1016/j.jfms.2011.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PRACTICAL RELEVANCE Although the surgical management of feline congenital portosystemic shunts (CPSSs) is normally performed at specialist centres, a good knowledge of treatment options and prognosis is important for the general practitioner when advising clients. CLINICAL CHALLENGES A variety of surgical techniques are described for the correction of CPSSs in cats. Choosing between the different techniques is a challenge, given the limited availability of evidence supporting one technique over another. In addition, postoperative complications, and in particular neurological complications, are seen more frequently in the cat than the dog and thus postoperative monitoring and treatment is critically important in feline patients. AUDIENCE This article summarises current evidence in surgical management and is aimed at practising veterinarians, postgraduate students and specialists alike. EQUIPMENT Surgical management of CPSSs typically requires advanced surgical and critical care facilities. The precise nature will depend to some extent on the technique employed. EVIDENCE BASE The evidence base for decision making in the surgical management of CPSSs is relatively sparse. In reviewing the evidence that is available, as well as the areas in which information is still lacking, this article may hopefully serve as a stimulus for further investigation into this condition.
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Affiliation(s)
- Michael Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinay College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK.
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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.
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Affiliation(s)
- Stephen N Greenhalgh
- Department of Veterinary Medicine, Veterinary School, University of Cambridge, Cambridge, CB3 0ES, England
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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]
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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]
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Bright SR, Williams JM, Niles JD. Outcomes of Intrahepatic Portosystemic Shunts Occluded with Ameroid Constrictors in Nine Dogs and One Cat. Vet Surg 2006; 35:300-9. [PMID: 16635012 DOI: 10.1111/j.1532-950x.2006.00148.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report outcome after ameroid constrictor (AC) use for single intrahepatic portosystemic shunts (IPSS). STUDY DESIGN Retrospective study. ANIMALS Nine dogs and 1 cat. METHODS Medical records (1999-2003) of dogs and cats with surgically confirmed IPSS were reviewed. Recorded data was: breed, sex, weight, age at surgery, clinical signs, serum biochemical and hematologic data, shunt anatomy, AC size, hospitalization, complications, and owner perception of their animal's response to surgery. Owners were contacted twice postoperatively (between 20 and 75 months) and asked to complete a simple questionnaire. RESULTS With this technique, complication rate was low and postligation neurologic dysfunction was not observed. In the cat and 7 dogs, clinical signs attributed to IPPS resolved and animals were fed a non-prescription diet without medication. One dog died suddenly 18 months after surgery from causes unrelated to hepatic disease. One dog was euthanatized 23 months after surgery because of repeated, increasingly refractory episodes of hepatic encephalopathy. CONCLUSION AC provides a safe and effective method for occlusion of some IPPS. CLINICAL RELEVANCE AC should be considered for occlusion of some IPPS in dogs and cats.
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Affiliation(s)
- Steven R Bright
- Small Animal Teaching Hospital, University of Liverpool and Oakwood Veterinary Referrals, Northwich, UK.
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Sereda CW, Adin CA. Methods of Gradual Vascular Occlusion and Their Applications in Treatment of Congenital Portosystemic Shunts in Dogs: A Review. Vet Surg 2005; 34:83-91. [PMID: 15720602 DOI: 10.1111/j.1532-950x.2005.00015.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To provide a comprehensive review of the experimental and clinical data related to gradual vascular occlusion of congenital portosystemic shunts (CPS) in dogs. STUDY DESIGN Literature review. METHODS PubMed literature search (1966-2004). RESULTS Surgical intervention and complete vascular occlusion have been recommended for CPS therapy in dogs; however, acute complete ligation of CPS is often associated with life-threatening portal hypertension. Recently, several investigators have attempted to reduce the risk of postoperative portal hypertension by using gradual vascular occlusion. Successful vascular occlusion has been achieved using partial ligation with silk suture, ameroid constrictors, cellophane bands, thrombogenic coils and hydraulic vascular occluders. Objective comparisons of the reliability and rate of vascular occlusion produced by each of these methods have been limited by differences in experimental models and a lack of definitive follow up evaluation in some clinical studies. CONCLUSIONS Gradual vascular occlusion is widely used in the clinical treatment of CPS in dogs. Objective evaluation of the experimental and clinical data on each of the techniques for gradual vascular occlusion is necessary for informed clinical practice and for the planning of future research into this important area. CLINICAL RELEVANCE Even from the limited data available, it is clear that the ideal method for gradual vascular occlusion of CPS has yet to be identified.
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Affiliation(s)
- Colin W Sereda
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610-0126, USA
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