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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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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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Mullins RA, Serrano Creheut T. Postattenuation neurologic signs after surgical correction of congenital portosystemic shunts in cats: A narrative review. Vet Surg 2023; 52:349-360. [PMID: 36630563 DOI: 10.1111/vsu.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/11/2022] [Accepted: 12/18/2022] [Indexed: 01/13/2023]
Abstract
Development of postattenuation neurological signs (PANS) is a potentially severe complication after surgical attenuation of congenital portosystemic shunts in cats. This review summarizes findings of 15 publications that report occurrence of PANS in cats. PANS includes seizures but also milder neurologic signs such as blindness, ataxia, abnormal behavior, tremors, and twitching. Incidence of PANS and specifically postattenuation seizures in studies including a minimum of five cats ranges from 14.3% to 62.0% and 0% to 32.0%, respectively. Etiology of PANS in cats is unknown, however, several hypotheses have been proposed including central nervous system disease/derangement, perioperative hypoglycemia and electrolyte disturbances, and postoperative portal hypertension. A number of possible risk factors have been identified including lower grades of intraoperative postocclusion mesenteric portovenography and osmolality at 24 h postoperatively. Evidence for use of prophylactic antiepileptics such as levetiracetam to prevent or reduce incidence of PANS in cats is limited and does not support their use. Because the cause is unknown, treatment is aimed at controlling neurologic signs, preventing progression to more severe signs, and providing general supportive care. Prospective studies comparing the efficacy of different antiepileptics for treatment of PANS in cats are required. Prognosis for recovery is variable and dependent on severity of neurologic signs. For cats surviving to discharge, long-term survival is possible but persistence or recurrence of neurologic signs in the long-term is not uncommon.
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Affiliation(s)
- Ronan A Mullins
- Department of Small Animal Surgery, Section of Small Animal Clinical Studies, University College Dublin, Dublin, Ireland
| | - Tomas Serrano Creheut
- Department of Small Animal Surgery, Section of Small Animal Clinical Studies, University College Dublin, Dublin, Ireland
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van Blokland-Post K, Weber MF, van Wolferen ME, Penning LC, van Sluijs FJ, Kummeling A. Prediction of outcome after ligation or thin film banding of extrahepatic shunts, based on plasma albumin concentration and hematologic expression of 8 target genes in 85 dogs. J Vet Intern Med 2023; 37:537-549. [PMID: 36934445 DOI: 10.1111/jvim.16680] [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: 04/22/2022] [Accepted: 02/22/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND In dogs with a congenital extrahepatic portosystemic shunt (EHPSS), outcome after surgical attenuation is difficult to predict. OBJECTIVES Develop a minimally invasive test to predict outcome after surgical EHPSS attenuation and establish risk factors for postattenuation seizures (PAS). ANIMALS Eighty-five client-owned dogs referred for surgical attenuation of a single EHPSS. METHODS mRNA expression of 8 genes was measured in preoperatively collected venous blood samples. Outcome was determined at a median of 92 days (range, 26-208) postoperatively by evaluating clinical performance, blood test results and abdominal ultrasonography. Multivariable logistic regression was used to construct models predicting clinical and complete recovery. The associations between putative predictors and PAS were studied using univariable analyses. RESULTS Five of 85 dogs developed PAS. Risk factors were age, white blood cell (WBC) count and expression of hepatocyte growth factor activator and LysM and putative peptidoglycan-binding domain-containing protein 2. Clinical recovery was observed in 72 of 85 dogs and complete recovery in 51 of 80 dogs (median follow-up, 92 days). The model predicting clinical recovery included albumin, WBC count, and methionine adenosyltransferase 2 alpha (MAT2α) expression, whereas the model predicting complete recovery included albumin, and connective tissue growth factor precursor and MAT2α expression. The areas under the receiver operating characteristic curves were 0.886 (95% confidence interval [CI]: 0.783, 0.990) and 0.794 (95% CI: 0.686, 0.902), respectively. CONCLUSIONS AND CLINICAL IMPORTANCE Two models were constructed for predicting outcome after EHPSS attenuation using venous blood samples. The model predicting clinical recovery showed the best diagnostic properties. Clinical application requires further validation.
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Affiliation(s)
- Krista van Blokland-Post
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Maarten F Weber
- Royal GD, P.O. Box 9, 7400 AA Deventer, The Netherlands.,Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Monique E van Wolferen
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Louis C Penning
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Freek J van Sluijs
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Anne Kummeling
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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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.
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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
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Wallace ML, Grimes JA, Edwards L, Lux CN, Tam C, Dickerson VM, Carroll KA, Scharf VF, Colberg V, Kudej RK, Otomo A, Singh A, Miller A, Regier PJ, Curcillo C, Holt DE, Ogden JA, Arai S, Upchurch DA, Eicher L, Howard J, Hardie RJ, Zellner EM, Milovancev M, Bennett B, Heape N, Matz BM, Schmiedt CW. Dogs ≥ five years of age at the time of congenital extrahepatic portosystemic shunt diagnosis have better long-term outcomes with surgical attenuation than with medical management alone. J Am Vet Med Assoc 2022; 260:758-764. [PMID: 35201999 DOI: 10.2460/javma.21.09.0417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the outcome in dogs diagnosed with congenital extrahepatic portosystemic shunts (EHPSS) at ≥ 5 years of age treated with medical management only (M) or with surgical attenuation (S). The hypothesis was that dogs undergoing surgical attenuation would have a longer survival time than dogs undergoing medical management only. ANIMALS 351 dogs definitively diagnosed with EHPSS at ≥ 5 years of age. PROCEDURES Medical records from 2009 to 2019 at 16 veterinary teaching hospitals were evaluated. Data collected included signalment, clinical signs at diagnosis, clinicopathologic data, surgical and medical treatments, shunt morphology, clinical signs and medical treatments at 6 to 12 months after diagnosis, and survival time. RESULTS 351 dogs (M, 119 [33.9%]; S, 232 [66.1%]) were included in the study. Survival time was longer with surgery than medical management (hazard ratio, 4.2; M, 3.4 years; S, 10.9 years). Continued clinical signs at 6 to 12 months after diagnosis were more common with medical management (M, 40% [33/88]; S, 14% [21/155]). Continued medical treatments at 6 to 12 months after diagnosis were more common in the medical management group (M, 78% [69/88]; S, 34% [53/155]). Perioperative mortality rate was 7.3%. CLINICAL RELEVANCE Dogs diagnosed at ≥ 5 years of age with EHPSS have significantly better survival times and fewer clinical signs with surgical attenuation, compared with medical management. Older dogs have similar surgical mortality rates to dogs of all ages after surgical EHPSS attenuation.
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Affiliation(s)
- Mandy L Wallace
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Janet A Grimes
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Lauren Edwards
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine University of Tennessee, Knoxville, TN
| | - Cassie N Lux
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine University of Tennessee, Knoxville, TN
| | - Candace Tam
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Vanna M Dickerson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Kenneth A Carroll
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Valery F Scharf
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Valerie Colberg
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Raymond K Kudej
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Aki Otomo
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Annellie Miller
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Chiara Curcillo
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - David E Holt
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica A Ogden
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN
| | - Shiori Arai
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN
| | - David A Upchurch
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Logan Eicher
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - James Howard
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Robert J Hardie
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI
| | - Eric M Zellner
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA
| | - Milan Milovancev
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR
| | - Barbara Bennett
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Natalie Heape
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Brad M Matz
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Chad W Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
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Wallace ML. Updates in Hepatobiliary Surgery. Vet Clin North Am Small Anim Pract 2022; 52:369-385. [DOI: 10.1016/j.cvsm.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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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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Carroll KA, Dickson RE, Scharf VF. Feasibility of thoracoscopic attenuation of the azygos vein as a model for portoazygos shunts: A canine cadaveric study. Vet Surg 2020; 50:345-352. [PMID: 33085107 DOI: 10.1111/vsu.13532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/09/2020] [Accepted: 10/02/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the feasibility of thoracoscopic placement of three vascular attenuation devices by using the azygos vein as a model for portoazygos (PA) shunts and to describe the approach for thoracoscopic placement of these attenuation devices in small breed dogs. STUDY DESIGN Randomized, prospective, cadaveric study. ANIMALS Cadavers of 10 adult small breed dogs. METHODS Cadavers were placed in sternal recumbency with left dorsolateral obliquity, and three thoracoscopic ports were established in the right hemithorax at the mid-10th intercostal space and dorsal third of the ninth and 11th intercostal spaces. The caudal azygos vein was thoracoscopically isolated along three adjacent segments bordered by four intercostal arteries, beginning just cranial to the first intercostal artery visualized cranial to the diaphragm. Three attenuation devices including coated cellophane, uncoated cellophane, and a 5-mm ameroid constrictor were thoracoscopically placed around one segment in each dog. Minor port access modifications were required to improve working space and triangulation in three dogs. Ability to successfully place the device, time required for placement, endoscopic clip configuration, and complications associated with placement were recorded. RESULTS Median dog weight was 7.7 kg (range, 1.8-11). All attenuation devices were successfully placed thoracoscopically in all cadavers. No difference was detected in time required for placement between the ameroid constrictor and coated and uncoated cellophane (range, 2.3-33.8 minutes, P = .8). CONCLUSION Ameroid constrictors and thin film bands were consistently placed via thoracoscopy around the caudal azygos vein of small breed dogs. CLINICAL SIGNIFICANCE These results justify further investigation of thoracoscopic PA shunt attenuation in affected dogs.
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Affiliation(s)
- Kenneth A Carroll
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Rachel E Dickson
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Valery F Scharf
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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