Anastomosis of the caudal thoracic duct and intercostal vein using a microvascular anastomotic coupler device: Experimental study in six dogs.

OBJECTIVE: To describe the technique for anastomosis of the caudal thoracic duct (TD) to the 10th or 11th intercostal vein (ICV) using a microvascular anastomotic coupler (MAC) device in dogs and assess patency of the anastomosis on days 0 and 30. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Six adult Beagle dogs. METHODS: Under general anesthesia, fluoroscopic popliteal lymphangiography was performed and the TD identified. A right ninth or 10th intercostal thoracotomy was performed. Using an operating microscope, the TD and the 10th or 11th ICV were isolated, ligated, and anastomosed using a 1.5 or 2.0 mm MAC. Fluoroscopic popliteal lymphangiography was repeated immediately after surgery and on day 30. RESULTS: The anastomosis was successful and lymphangiography documented flow into the azygos vein in all six dogs immediately after surgery. At day 30, the anastomosis was patent in four of six dogs. In two dogs, flow through the anastomosis was obstructed due to kinking of the ICV just cranial to the MAC. CONCLUSION: Anastomosis of the TD and ICV using a MAC was feasible and was shown to maintain patency up to 30 days. When performing the anastomosis, care should be taken to ensure the ICV is not kinked by the MAC. CLINICAL SIGNIFICANCE: Direct anastomosis of the TD and ICV may have application for treatment of idiopathic chylothorax in dogs by maintaining flow from the abdominal lymphatics to the central venous circulation and thereby preventing the stimulus for collateral circulation and persistent chylous effusion. Further investigation is warranted to assess the efficacy of this technique in dogs affected with idiopathic chylothorax.

Lymphaticovenous anastomosis of the caudal thoracic duct to the azygous vein: A feline cadaver study.

OBJECTIVE: The aim of this study was to describe a technique for anastomosis of the thoracic duct (TD) to the azygos vein (AV) using a microvascular anastomotic coupler (MAC) device in feline cadavers. Our hypothesis was that a TD-AV lymphaticovenous anastomosis would be feasible in feline cadavers. STUDY DESIGN: Cadaveric study. ANIMALS: Eight domestic shorthair feline cadavers. METHODS: A left paracostal laparotomy and 9th or 10th intercostal thoracotomy was performed. Contrast media was injected into a mesenteric lymph node and lymphography was used to identify the TD and its branches. The TD and AV were isolated, ligated, and divided with the aid of a surgical microscope. The TD and AV were anastomosed end-to-end using a 1.5 or 2.0 mm MAC. Intraoperative patency was assessed by manipulation of chyle and venous blood across the anastomosis. Mesenteric lymphography was repeated to confirm postoperative anastomotic patency. RESULTS: The TD was identified via lymphography in seven of eight cats. The anastomosis was successful and patency was confirmed via intraoperative assessment and postoperative lymphography in all cats. The median (range) duration for the dissection and anastomosis portions of the procedure was 122 (80-150) min. CONCLUSION: End-to-end anastomosis of the TD to the AV using a MAC was feasible in the feline cadaver without major intraoperative technical challenges. CLINICAL SIGNIFICANCE: Anastomosis of the TD and AV may have application as an alternative treatment for idiopathic chylothorax in cats. By directly connecting the abdominal lymphatics to the central venous system, the stimulus for collateral vessel development around the site of TD ligation may be minimized, which may prevent leakage of chyle through the more cranial lymphatics.

Computed tomographic findings in a canine ovarian teratoma.

A 2-year-old, intact female, Labrador Retriever was referred for progressive abdominal distension, assessed by emergency clinicians as being extrauterine in origin on AFAST. Abdominal radiographs and ultrasound identified a large, lobulated, partially mineralized, soft tissue, mid-abdominal mass and gravid uterus. Contrast-enhanced CT identified a mixed fat to soft tissue attenuating mass with a complex internal mineralized matrix, heterogeneous contrast enhancement, receiving blood from the left ovarian artery. Histology confirmed a left ovarian teratoma, diffuse endometrial hyperplasia, and fetal implantation. The patient had a good post-operative outcome for 2 years, but was later diagnosed with primary cranial mediastinal neuroendocrine carcinoma.

Anatomical classification of feline congenital extrahepatic portosystemic shunts based on CT angiography: A SVSTS and VIRIES multi-institutional study in 231 cats.

The prevalence of anatomical-based subtypes of feline congenital extrahepatic portosystemic shunts (EHPSS) has not been completely elucidated. The goal of this study was to use CT angiography to create an anatomical-based nomenclature system for feline congenital EHPSS. Additionally, subjective portal perfusion scores were generated to determine if intrinsic portal vein development was associated with different shunt conformations or patient age at the time of CT. The SVSTS and VIRIES list services were used to recruit cases. Data collected included patient DOB, gender, breed, weight, CT date, and reported diagnosis. Shunts were classified based upon (1) the shunt portal vessel(s) of origin, (2) the shunt systemic vessel(s) of insertion, and (3) any substantial portal vessels contributing to the shunt. Additionally, hepatic portal perfusion was subjectively scored between 1 (poor/none) and 5 (good/normal) based on the caliber of the intrahepatic PVs. A total of 264 CT scans were submitted from 29 institutions. Due to exclusion criteria, 33 (13%) were removed, leaving 231 CT scans to be included. Twenty-five different EHPSS anatomies were identified with five classifications accounting for 78% of all shunts (LGP [53%], LGC-post [11%], LCG [7%], LGC-pre [4%], and PC [4%]). Shunt origin involved the left gastric vein in 75% of the described classifications. Significant differences were identified among the five most common shunt types with respect to age at the time of CT scan (P = .002), breed (P < .001), and subjective portal perfusion score (P < .001). This refined anatomical classification system for feline EHPSS may enable improved understanding, treatment comparisons, and outcome prediction for cats with these anomalies.

Evaluation of two nephrocystostomy techniques for ureteral bypass in cats.

OBJECTIVE: To describe two techniques for nephrocystostomy (NCT) in cats. STUDY DESIGN: Experimental study. ANIMALS: Twelve, adult, purpose-bred, cats. METHODS: A simple NCT (n = 3) or bladder cuff NCT (n = 9) was performed in the right or left kidneys. For simple NCT, an 8F catheter was placed through the caudal pole into the renal pelvis and the bladder was sutured around the catheter. For bladder cuff NCT, a 6 mm defect was removed from the caudal pole and a cuff of bladder mucosa was advanced and sutured into the renal pelvis. A 10F catheter was placed through the defect into the renal pelvis and the bladder wall was sutured around the catheter. Catheters were removed 41-118 days post-surgery. Computed tomography (CT) was performed 25 days after catheter removal for the simple NCT and 30 (n = 6) and 90 (n = 3) days after catheter removal for bladder cuff NCT. Histological evaluation of the nephrocystostomy site was performed. RESULTS: All simple NCTs became obstructed after catheter removal. All bladder cuff NCTs were patent, and CT revealed contrast flow into the bladder. Hematuria, clot-associated urethral obstruction, catheter dislodgement, and bladder infection occurred variably after surgery. Histological findings consisted of smooth epithelialization of the NCT and degenerative changes in the caudal pole of the kidney. CONCLUSION: Bladder cuff NCT was feasible in normal cats and remained patent for 90 days. Methods to limit nephrostomy track hemorrhage should be investigated. Degenerative changes may be related to vascular impairment from the bladder cuff sutures. CLINICAL SIGNIFICANCE: Complete ureteral bypass was possible in cats using only native tissues.

Evaluation of a microvascular anastomotic coupler for end-to-side arterial and venous anastomosis for feline renal transplantation.

OBJECTIVE: To describe the technique and determine the feasibility of an end-to-side (ETS) anastomosis of the renal vein to vena cava and renal artery to aorta using a microvascular anastomotic coupler (MAC) for feline renal transplantation. STUDY DESIGN: In vivo experimental study. ANIMALS: Six purpose-bred domestic shorthair cats. METHODS: The left kidney was autotransplanted using a MAC for ETS vascular anastomosis. Outcomes included intraoperative hemorrhage from the anastomosis sites, duration of anastomoses, surgical complications, postoperative renal perfusion (including resistive index (RI)) measured by Doppler ultrasonography and computed tomography angiography, and histopathological examination of the left kidney and anastomosis sites (30 days). RESULTS: Anastomosis was successful in all cats, and intraoperative hemorrhage was negligible. Intraoperative renal perfusion was considered excellent. Venous and arterial anastomoses were completed in 11 minutes 20 seconds (range, 6:38-13:27) and 21 minutes 50 seconds (range, 11:05-30:24), respectively. Vascular occlusion time was 32 minutes (17:43-42:03). One cat was euthanized 5 hours postoperatively because of bleeding from a muscular arterial branch of the dorsal aorta causing hemoabdomen. Renal perfusion and RI of the remaining five cats were within normal range (<0.8) and similar to the contralateral kidney at all time points. Endothelialization of the anastomosis was complete with mild-to-moderate fibrosis surrounding the MAC in all cats. CONCLUSION: End-to-side anastomosis of the renal vein and artery to the vena cava and aorta, respectively, was consistently achieved in all six cats with the MAC. CLINICAL SIGNIFICANCE: The use of the MAC may be considered as an alternative to hand suturing for ETS anastomoses for feline renal transplantation.

Lymphaticovenous anastomosis of the caudal thoracic duct to an intercostal vein: A canine cadaver study.

OBJECTIVE: To describe a technique for anastomosis of the thoracic duct (TD) to the 11th or 12th intercostal vein (ICV) using a microvascular anastomotic coupler (MAC) in the dog. STUDY DESIGN: Cadaveric study. ANIMALS: Eight beagles. METHODS: A right paracostal laparotomy and 10th intercostal thoracotomy were performed in each dog. Mesenteric contrast lymphography was used to identify the TD and its branches on fluoroscopy. The TD and adjacent 11th or 12th ICV were isolated, double ligated, and divided using a surgical microscope. The caudal TD and proximal ICV were anastomosed in an end-to-end fashion using a 1.5 mm or 2 mm MAC. Mesenteric lymphography was repeated to document patency of the anastomosis. RESULTS: The TD was identified via lymphography in all dogs; five dogs had a single duct, and three dogs had additional branches. The anastomosis was successful in all eight dogs, and flow into the azygos vein without leakage was confirmed via lymphography. CONCLUSION: End-to-end anastomosis of the TD to an ICV using a MAC was technically feasible in the canine cadaver. CLINICAL SIGNIFICANCE: Lymphaticovenous anastomosis combined with TD ligation may have application as a treatment for idiopathic chylothorax. By maintaining the flow of chyle from the abdominal lymphatics to the systemic circulation, this procedure may reduce the stimulus for collateral circulation and persistent flow to the cranial mediastinal lymphatics.

An Interdisciplinary Approach to Surgical Skills Training Decreases Programmatic Costs.

BACKGROUND: Surgical resident duty hour limitations have necessitated operative skill training outside of the operating room. Although wet-lab skills training is ideal, materials and human resource requirements make wet labs-utilizing biologic samples cost prohibitive for many residency programs. To resolve this problem, our general surgery residency program collaborated with the Institution's School of Veterinary Medicine Surgery Residency program to pilot a cost-effective interdisciplinary surgical skills curriculum. MATERIALS AND METHODS: The general surgery residency program manager and program director initiated a collaboration with the Veterinary Surgery Residency. Postgraduate year (PGY) 2 general surgery residents and PGY 1-3 veterinary surgery residents participated in monthly joint surgical skills practice sessions. A novel interdisciplinary surgical skills curriculum was implemented that incorporated skills beneficial to both sets of trainees utilizing donated canine cadavers. RESULTS: A total of nine joint skills sessions were conducted for nine general surgery residents and five veterinary surgery residents. A cost analysis was conducted for a surgical skills curriculum servicing both programs independently and compared to the actual costs of the collaborative curriculum. The cost analysis estimated total savings generated by the collaborative to be $27,323.79. Review of initial feedback from trainees suggest that skill sessions reinforce knowledge, and that the collaborative skills sessions were an enjoyable and valuable learning activity. CONCLUSIONS: The skills curriculum collaborative has proven to be a cost-effective and high quality interdisciplinary pedagogic tool. The partnership allowed for mutually beneficial resource sharing and allowed for the initiation of a surgical skills wet lab that had previously been unavailable to both groups.

Intraoperative and major postoperative complications and survival of dogs undergoing surgical management of epiglottic retroversion: 50 dogs (2003-2017).

OBJECTIVE: To report intraoperative and major postoperative complications in dogs treated surgically for epiglottic retroversion (ER), compare the incidence of major postoperative complications between procedures, and report survival of surgically treated dogs. STUDY DESIGN: Multi-institutional retrospective study. SAMPLE POPULATION: Fifty dogs treated with 78 procedures. METHODS: Medical records of dogs diagnosed and surgically treated for ER from 2003 to 2017 at 11 institutions were reviewed. Complications were divided into intraoperative and major postoperative complications. RESULTS: Intraoperative complications occurred during 2 of 78 (2.6%) procedures. Thirty-six major postoperative complications were documented in 22 dogs after 36 of 74 (48.7%) procedures. Postoperative complications occurred after 7 of 12 (58.3%) nonincisional epiglottopexy, 23 of 43 (53.5%) incisional epiglottopexy, 2 of 4 (50%) partial epiglottectomy, 2 of 12 (16.7%) subtotal epiglottectomy, and 2 of 3 (66.7%) other surgical procedures. Epiglottopexy failure was the most common major postoperative complication. The incidence of major postoperative complications did not differ between procedures (P = .1239), although, when combined, epiglottopexy procedures (30/55) had a higher incidence of complications than epiglottectomy procedures (4/16; P = .048). Thirty (60%) dogs were alive at a median of 928 days (range, 114-2805), 8 (16%) were lost to follow-up after 411 days (range, 43-1158), and 12 (24%) were dead/euthanized after 301.5 days (range, 3-1212). Median survival time was not reached after a median of 716 days. CONCLUSION: Although intraoperative complications were uncommon, major postoperative complications were common, especially after epiglottopexy procedures. CLINICAL SIGNIFICANCE: Although surgical treatment of ER is associated with a high rate of major postoperative complications, especially epiglottopexy procedures, long-term survival can be achieved.

Comparison of the effects of alfaxalone and propofol with acepromazine, butorphanol and/or doxapram on laryngeal motion and quality of examination in dogs.

OBJECTIVE: To compare the effects of alfaxalone and propofol, with and without acepromazine and butorphanol followed by doxapram, on laryngeal motion and quality of laryngeal examination in dogs. STUDY DESIGN: Randomized, crossover, blinded study. ANIMALS: Ten female Beagle dogs, aged 11-13 months and weighing 7.2-8.6 kg. METHODS: The dogs were administered four intravenous (IV) treatments: alfaxalone (ALF), alfaxalone+acepromazine and butorphanol (ALF-AB), propofol (PRO) and propofol+AB (PRO-AB). AB doses were standardized. Dogs were anesthetized 5 minutes later by administration of alfaxalone or propofol IV to effect. Arytenoid motion during maximal inspiration and expiration was captured on video before and after IV doxapram (0.25 mg kg-1). The change in rima glottidis surface area (RGSA) was calculated to measure arytenoid motion. An investigator blinded to the treatment scored laryngeal examination quality. RESULTS: A 20% increase in RGSA was the minimal arytenoid motion that was detectable. RGSA was significantly less in ALF before doxapram compared with all other treatments. A <20% increase in RGSA was measured in eight of 10 dogs in PRO and in all dogs in ALF before doxapram. After doxapram, RGSA was significantly increased for PRO and ALF; however, 20% of dogs in PRO and 50% of dogs in ALF still had <20% increase in RGSA. A <20% increase in RGSA was measured in five of 10 dogs in PRO-AB and ALF-AB before doxapram. All dogs in PRO-AB and ALF-AB with <20% increase in RGSA before doxapram had ≥20% increase in RGSA after doxapram. Examination quality was significantly better in PRO-AB and ALF-AB. CONCLUSIONS AND CLINICAL RELEVANCE: The use of acepromazine and butorphanol improved the quality of laryngeal examination. Any negative impact on arytenoid motion caused by these premedications was overcome with doxapram. Using either propofol or alfaxalone alone is not recommended for the evaluation of arytenoid motion.

A Carrel patch technique for renal transplantation in cats.

OBJECTIVE: To evaluate the feasibility of a Carrel patch method in feline renal transplantation. STUDY DESIGN: Descriptive case series. ANIMALS: Nine healthy donor cats and 9 client recipient cats with chronic renal failure. METHODS: Renal transplantation was performed in 9 cats with chronic renal failure after collection of a donor's left kidney with a Carrel patch technique. A patch of donor aortic wall was removed with either 2 or 1 renal artery (ies) (n = 1 and 8 cats, respectively) central to the patch, with a cuff of tissue (≤1 mm) protruding from the base of the vessels. The Carrel patch was implanted in recipient cats with an end-to-side artery-to-aorta anastomosis, in a simple-continuous pattern of 9-0 nylon. The renal vein and ureter were implanted as previously described. RESULTS: All donors and recipients survived surgery without vascular complication. CONCLUSION: The Carrel patch is a novel approach allowing the harvest of kidneys with multiple renal arteries. The technique also simplified the implant procedure, potentially decreasing the risks of bleeding and thrombosis.

Ureteral Papilla Implantation as a Technique for Neoureterocystostomy in Cats Undergoing Renal Transplantation: 30 Cases.

OBJECTIVE: To describe the clinical outcome of donor and recipient cats undergoing ureteral papilla harvest and implantation as a technique for neoureterocystostomy in clinical kidney transplant. STUDY DESIGN: Retrospective case series. ANIMALS: Donor (n=31) and recipient (n=30) cats that underwent kidney harvest and transplantation using ureteral papilla implantation technique for neoureterocystostomy. METHODS: Medical records for donor and recipient cats presented to the University of Wisconsin Veterinary Teaching Hospital from January 2003 to December 2014 were reviewed. Data recorded included complete blood count, serum chemistry panel, surgical technique, diagnostic imaging results, short- and long-term complications, and anesthetic survival. RESULTS: All 30 recipients recovered from anesthesia. Four died within 24 hours and 26 survived to hospital discharge. Serum creatinine was within the reference interval by 72 hours in 22/26 cats (85%). Complications related to the ureteral papilla implantation technique were seen in only 1 cat (3%). Uroabdomen diagnosed on day 3 ultimately resolved over the following 24 hours without surgical intervention. All 31 donor cats survived to discharge. Four donors (13%) experienced mild, transiently increased serum creatinine. CONCLUSION: Ureteral papilla implantation is a viable technique for neoureterocystostomy in cats undergoing kidney transplantation. Proposed benefits for the recipient include a less technically challenging anastomosis, decreased risk of ureteral obstruction at the anastomosis site, and reduced risk of leakage compared to previous reports. Benefits for recipients should be weighed against risks to donors, including a more complex ureteral harvest, increased surgical time, and potential injury or obstruction of the contralateral ureteral papilla.

Outcome of Donor Cats After Unilateral Nephrectomy as Part of a Clinical Kidney Transplant Program.

OBJECTIVE: To compare 1) complications between 2 ureteral harvest techniques (ureteral papilla harvest [UPH] and ureteral transection [UT]); 2) to investigate the prevalence of kidney failure in a population of kidney donors; and 3) to evaluate owner satisfaction with commercially sourced cats adopted after kidney donation. STUDY DESIGN: Retrospective case series. ANIMALS: Cats (n = 72) that had unilateral nephrectomy for kidney donation. METHODS: Medical records were reviewed and information on short- and long-term complications and evidence of kidney failure was recorded. Clients were interviewed by telephone to ascertain their satisfaction with the adopted donor cats as pets. RESULTS: Seventy-two cats had unilateral nephrectomy. Forty-two owners were able to be contacted for survey data. Twenty-eight cats had complete medical records including serum BUN, creatinine, and urine specific gravity. For these 28 cats, mean age at nephrectomy was 1.9 years (median, 1.1 years; range, 0.5-9.3 years) and mean age at follow-up was 6.8 years (median, 5.1 years; range, 1.0-18.7 years). There was no difference in major or minor complication rates between UPH and UT techniques. Kidney failure occurred in 17.8% of cats. All owners were satisfied with the adopted donor cats, which were obtained from commercial facilities. CONCLUSIONS: UPH is a safe technique in cats being used for kidney donation. Commercially sourced cats make suitable pets after kidney donation. The prevalence of kidney failure in the donor population appears to be higher than that in the general population, but definitive conclusions cannot be made based on this study. Further, prospective study is needed to identify the true prevalence of kidney failure in cats after unilateral nephrectomy.

Surgical excision of the parotid salivary gland for treatment of a traumatic mucocele in a dog.

A 3 yr old spayed female mixed-breed German shepherd dog was presented with a right facial swelling that developed after fighting with another dog. A parotid salivary mucocele was diagnosed via physical examination, fine-needle aspirate, and sialography of the parotid and mandibular salivary glands. Surgical excision of the right parotid salivary gland and duct was performed along with drainage of the mucocele. Neither intraoperative nor postoperative complications occurred, and follow-up examination 4 mo later revealed no evidence of recurrence. Case outcome was considered excellent. Sialography was useful for confirming the parotid gland as the source of the mucocele. Surgical excision of the parotid salivary gland is technically challenging, but an effective treatment option for traumatic mucoceles in the dog.

Use of a custom orthotic boot for management of distal extremity and pad wounds in three dogs.

OBJECTIVE: To describe use of a custom orthotic boot for management of distal extremity and pad wounds in dogs. STUDY DESIGN: Clinical report. ANIMALS: Dogs (n = 3). METHODS: A custom orthotic boot made of lightweight copolymer plastic was used to immobilize the distal extremity and protect full-thickness wounds involving the medial or lateral aspect of the metatarsus including a portion of the metatarsal pad in 3 dogs. Boots were made in a bivalve design with closed-cell foam padding and adjustable straps that allowed for easy application. They were molded with the tarsocrural joint in slight hyperextension and the metatarsophalangeal joints in a neutral position so that the wounds and metatarsal pads were "off weighted" when the dogs were standing. In addition, a "window" was cut out directly over the wounds to minimize direct contact between the boot and the wound. RESULTS: Wounds healed by contraction and epithelialization in 21, 21, and 45 days. The only complication encountered was mild skin irritation at the top of the boot in 2 dogs that was managed with additional closed-cell foam padding. CONCLUSION: A custom orthotic boot was effective at immobilizing the distal extremity and reducing contact between the wound and the boot which allowed for complete healing by contraction and epithelialization.

Minimally invasive surgery in veterinary practice: a 2010 survey of diplomates and residents of the American College of Veterinary Surgeons.

OBJECTIVE: To report the current state of minimally invasive surgery (MIS) in veterinary surgical practice in 2010. STUDY DESIGN: Electronic questionnaire. SAMPLE POPULATION: Diplomates and residents of the American College of Veterinary Surgeons (ACVS). METHODS: A survey (38 questions for Diplomates, 23 questions for residents) was sent electronically to 1216 Diplomates and 300 residents. Questions were organized into 5 categories to investigate: (1) caseload and distribution of MIS cases; (2) MIS training; (3) MIS benefits, morbidity, limitations and motivating factors; (4) ACVS role; and (5) demographics of the study population. RESULTS: Eighty-six percent of small animal (SA) Diplomates, 99% of large animal (LA) Diplomates, and 98% of residents had performed MIS. Median LA caseload (30 cases/year; range, 1-600) was significantly higher than SA caseload (20 cases/year; range, 1-350). Descending order of case distribution was: arthroscopy > laparoscopy > endoscopic upper airway > thoracoscopy. Sixty percent of Diplomates and 98% of residents received MIS training during their residency. Residents' perspective of MIS training proficiency was positively correlated to caseload. Ninety-five percent of all respondents felt postoperative morbidity was less with MIS, and were motivated by patient benefits, maintaining a high standard of care, and personal interests. Fifty-eight percent of Diplomates and 89% of residents felt ACVS should be involved in developing MIS training. CONCLUSIONS: MIS is widely used by ACVS Diplomates and residents in clinical practice; however, important differences exist between SA and LA surgeons and practice types. MIS training in partnership with the ACVS is needed for continued development in veterinary surgery.

Evaluation of submucosally injected polyethylene glycol-based hydrogel and bovine cross-linked collagen in the canine urethra using cystoscopy, magnetic resonance imaging and histopathology.

OBJECTIVE: To (1) investigate the tissue response to a novel urethral bulking agent, polyethylene glycol carboxymethyl cellulose hydrogel (PEG-CMC) injected submucosally in the canine urethra and (2) compare PEG-CMC with bovine collagen (BC), the current standard for urethral bulking. STUDY DESIGN: Experimental study. ANIMALS: Purpose-bred female hound dogs (n = 8). METHODS: Standardized submucosal urethral injections of BC and PEG-CMC were performed in 8 female dogs. Injection sites were evaluated by cystoscopy on days 0 (n = 8), 30 (n = 4), and 90 (n = 4), magnetic resonance imaging on days 0 (n = 8), 30 (n = 8), and 90 (n = 4) and by histopathology on days 30 (n = 4) and 90 (n = 4). RESULTS: Both PEG-CMC and BC were detectable on MRI as hyperintense foci on T2-weighted images. Grossly, PEG-CMC formed more prominent blebs than BC. On follow-up cystoscopic examination, 6/8 PEG-CMC injection needle tracts were visible, and 3 of these sites had mucosal erosions. Histopathologic scores for foreign body reaction and inflammation were significantly higher for PEG-CMC compared with BC (P < 0.005). BC elicited a lymphoplasmacytic reaction whereas PEG-CMC incited a granulomatous response. CONCLUSIONS: The overall physical characteristics and histologic response associated with PEG-CMC support its use as a urethral bulking agent; however, the current formulation needs to be adjusted for clinical use.

Retroperitoneal fibrosis as a postoperative complication following renal transplantation in cats.

OBJECTIVES: The aim of this report was to describe the clinical signs, diagnostic imaging findings, surgical management, histopathological findings, outcome and possible risk factors for cats that developed retroperitoneal fibrosis (RPF) following renal transplantation. METHODS: Medical records of cats that underwent renal transplantation and developed clinically significant RPF between 1995 and 2019 were reviewed. RESULTS: Eighty-one cats underwent 83 renal transplantations. Of these 81 cats, six developed clinically significant RPF. For all six cats, renal transplantation was performed using cold organ preservation solution and ureteral papilla implantation. Immunosuppression protocol included ciclosporin and prednisolone. All cats had at least one subtherapeutic trough ciclosporin level (<250 ng/ml) in the postoperative period. Cats presented with moderate-to-severe azotemia 39-210 days following renal transplantation. Abdominal ultrasonography and contrast pyelography revealed various degrees of hydroureter and hydronephrosis of the transplanted kidney. Surgical examination revealed a layer of dense fibrous tissue surrounding the transplanted kidney, ureter and bladder resulting in ureteral obstruction. Ureteral obstruction was managed by reimplantation of the proximal ureter or renal pelvis to the bladder. Histopathologic examination of the fibrous tissue and affected portion of the distal ureter revealed fibrous connective tissue with lymphoplasmacytic infiltration and perivascular inflammation suggestive of an autoimmune type reaction. Of the six cats, two died within 5 days after revision surgery, two developed signs consistent with recurrent partial ureteral obstruction (40 and 41 days after revision), one was euthanized 6 years later for an unrelated disease and one was lost to follow-up. CONCLUSIONS AND RELEVANCE: The incidence of RPF in this population of cats was relatively low (7%), but still represents a significant cause of morbidity and mortality. The cause of RPF remains unknown, although investigation into suboptimal immunosuppression as a potential cause for local rejection reaction is warranted.

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.

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.

Use of the PleuralPort device for management of pleural effusion in six dogs and four cats.

OBJECTIVE: To describe the placement technique, complications, and outcomes associated with use of the PleuralPort device for management of pleural effusion in dogs and cats. STUDY DESIGN: Case Series. ANIMALS: Six dogs and 4 cats. METHODS: Medical records of all animals with pleural effusion managed with the PleuralPort device were reviewed. Data regarding signalment, fluid analysis, placement technique, duration of function, duration of implantation, complications, and outcome were collected. Owners and referring veterinarians were contacted for follow-up information. RESULTS: Nine animals had chylous effusion and 1 dog had pleural carcinomatosis. Eleven ports were placed with 1 cat receiving bilateral ports. Four animals developed complications. One cat developed pneumothorax immediately after implantation and was euthanatized. In 2 dogs and 1 cat, the ports obstructed. The 6 remaining animals had functioning ports at time of death or resolution of effusion and no longer required use of the port. No significant port migration, irritation, or infection of the device was reported. Excluding the cat with pneumothorax, median duration of port function was 20 days (range 1-391), and median duration of port implantation was 391 days (range 6-723). CONCLUSIONS: The PleuralPort device is a feasible option for the management of pleural effusion in dogs and cats.