Clinical use of uncovered balloon-expandable metallic biliary stents for treatment of extrahepatic biliary tract obstructions in cats and dogs: 11 cases (2012-2022).

OBJECTIVE: To describe the application of uncovered balloon-expandable metallic biliary stents for treatment of extrahepatic biliary obstructions (EHBOs) and the outcomes for dogs and cats treated for EHBO with this technique. STUDY DESIGN: Retrospective single institutional study. ANIMALS: Eight dogs and three cats treated at the Veterinary Specialty Hospital of San Diego for EHBO between January 2012 and February 2022. METHODS: Data collected from the medical records included signalment, presenting complaint, laboratory and imaging findings, surgical findings, hospitalization time, complications, and follow-up information. RESULTS: Median duration of short-term follow up was 16 days (6-45 days). Improved biochemical abnormalities and resolution of clinical signs were recorded in 10/11 cases. Two dogs died within 2 weeks of surgery. One dog developed systemic inflammatory response syndrome 5 days postoperatively and was euthanized; the cause of death in the second case was unknown. Long-term follow up was available in seven cases, with a median duration of 307.5 days (62-2268 days). Bile-duct patency was maintained for at least 356-622 days (median: 446 days) in three cats and 62-2268 days (median: 650.5 days) in four dogs with long-term follow up available. One cat had recurrent obstruction with choledocholiths 446 days postoperatively. One stent was removed 614 days postoperatively due to recurrent cholangiohepatitis. CONCLUSION: Uncovered balloon-expandable metallic biliary stents were placed successfully and relieved EHBO in all cases that survived to discharge. CLINICAL SIGNIFICANCE: Use of uncovered balloon-expandable metallic biliary stents should be considered as an alternative to temporary choledochal luminal stenting or cholecystoenterostomy to manage EHBO.

The cardiovascular effects of sevoflurane and isoflurane after premedication of healthy dogs undergoing elective surgery.

Sevoflurane and isoflurane are commonly used in veterinary anesthesia. The objective of this prospective, randomized, open-label clinical study was to compare the cardiovascular effects of sevoflurane and isoflurane via direct arterial blood pressure measurements and the lithium dilution cardiac output (LDCO) on premedicated healthy dogs undergoing elective tibial plateau leveling osteotomy (TPLO). Nineteen client-owned dogs were included. All dogs were premedicated with hydromorphone (0.05 mg/kg IV and glycopyrrolate 0.01 mg/kg subcutaneously). Ten dogs were anesthetized with sevoflurane and nine dogs were anesthetized with isoflurane. Eighteen dogs were instrumented with a dorsal pedal arterial catheter, and one dog had a femoral arterial catheter. All dogs had continuous, direct systolic (SAP), diastolic (DAP), and mean arterial (MAP) blood pressure readings as well as heart rate (HR), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), stroke volume variation (SVV), and pulse pressure variation (PPV) recorded q 5 min during the surgical procedure. There was no significant statistical difference in all parameters between the sevoflurane and isoflurane treatment groups. Both sevoflurane and isoflurane inhalant anesthetics appear to have similar hemodynamic effects when used as part of a multimodal anesthetic protocol in premedicated healthy dogs undergoing an elective surgical procedure.

Reduction and fixation of cranial cervical fracture/luxations using screws and polymethylmethacrylate (PMMA) cement: a distraction technique applied to the base of the skull in thirteen dogs.

OBJECTIVE: To (1) describe a surgical distraction technique for C1-2 cervical fractures/luxations or atlantoaxial (AA) subluxations using the base of the skull (basion of the foramen magnum) and either C2-3 or C3-4 for the purchase points of intraoperative axial distraction and (2) report outcome in 13 dogs. STUDY DESIGN: Retrospective case series. ANIMALS: Dogs (n = 13). MATERIALS AND METHODS: Medical records (September 1995-December 2005) of dogs with fracture/luxation of the cervical spine, or AA subluxations, were reviewed. Only dogs that had intraoperative linear distraction using the base of the skull as a purchase point for a self-retaining retractor were included. Signalment, presenting neurologic deficits, fracture location, and concurrent injury were recorded. Both short-term in-hospital follow-up, including healing and any complications, and long-term telephone follow-up were obtained. RESULTS: Realignment of the spinal vertebrae, reestablishing the normal properties of the spinal canal, was achieved after distraction in all dogs. Screws and small pins incorporated into polymethylmethacrylate cement were used to span the fracture ventrally and achieve rigid internal fixation. Eight dogs had a complete neurologic recovery, 2 dogs had slight residual ataxia, 2 dogs died, and 1 dog was lost to follow-up. Healing was good (mean, 7.5 weeks) or excellent (mean, 5.1 months) based on in-hospital follow-up (mean, 5.1 months). On final telephone follow-up (mean, 7.7 years), no dogs were reported to have had any associated problems or additional surgery. CONCLUSIONS: This surgical distraction technique was a reliable, relatively simple method to obtain reduction of fracture/luxations of C1-2 to re-align the spinal canal. Mortality in this series appears lower than that previously reported and supports surgical management of these injuries.

Gallbladder mucocele in dogs: 30 cases (2000-2002).

OBJECTIVE: To determine long-term outcome of dogs with gallbladder mucocele. DESIGN: Retrospective study. ANIMALS: 30 dogs with gallbladder mucocele, including 23 that underwent cholecystectomy. PROCEDURE: Medical records were reviewed for signalment, history, and clinical, ultrasonographic, and surgical findings. Follow-up information was obtained for all dogs that survived the perioperative hospitalization period. RESULTS: 23 dogs had signs of systemic illness; 7 had no clinical signs. Median values for serum activities of alanine aminotransferase and alkaline phosphatase, serum total bilirubin concentration, and total WBC count were significantly higher among dogs with gallbladder rupture than among dogs without rupture. Sensitivity of sonography for detection of rupture was 85.7%. Overall perioperative mortality rate for dogs that underwent cholecystectomy was 21.7%; mortality rate was not significantly greater for dogs with rupture. Aerobic bacteria were isolated from the bile or gallbladder wall in 8.7% of dogs. All 18 dogs discharged from the hospital had complete resolution of clinical signs. In dogs that underwent in-hospital reexamination, serum liver enzyme activities were significantly decreased, compared with preoperative activities. Persistent increases in serum activities of 1 or more liver enzymes were detected in 9 of 12 dogs; 6 of 12 dogs had persistent abnormalities in hepatic echogenicity. Mean follow-up period was 13.9 months. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that cholecystectomy is an effective treatment for gallbladder mucocele. Although perioperative mortality rate is high, prognosis after discharge from the hospital is excellent. Rupture of the gallbladder warrants emergency surgical intervention but does not preclude a positive outcome.