Comparison of manual compression, Z-stitch, and suture-mediated vascular closure device techniques in dogs undergoing percutaneous transvenous intervention.

INTRODUCTION/OBJECTIVES: Manual compression has been standard of care for maintaining hemostasis after percutaneous endovascular intervention, but can be time-consuming and associated with vascular complications. Alternative closure methods include the figure-of-eight suture (Z-stitch) and vascular closure device (VCD) techniques. We hypothesized that compared to manual compression, Z-stitch and VCD would significantly reduce time-to-hemostasis after transvenous access, and the proportion of dogs with vascular patency would not differ significantly among treatments. ANIMALS: Forty-six client-owned dogs undergoing percutaneous transvenous interventional procedures. MATERIALS AND METHODS: Dogs with vessel diameter <5 mm were randomized to undergo manual compression or Z-stitch, while those with vessel diameter ≥5 mm were randomized to undergo manual compression, Z-stitch, or VCD. Time-to-hemostasis, bleeding scores, presence of vascular patency one day and two to three months post-procedure, and complications were recorded. Data are presented as median (95% confidence interval). RESULTS: In all 46 dogs, the right external jugular vein was used. Time-to-hemostasis was significantly shorter in the Z-stitch (2.1 [1.8-2.9] minutes) compared to VCD (8.6 [6.1-11.8] minutes; P<0.001) and manual compression (10.0 [10.0-20.0] minutes; P<0.001) groups. Time-to-hemostasis was significantly shorter in the VCD vs. manual compression (P=0.027) group. Bleeding scores were significantly greater at 5 and 10 min (P<0.001 and 0.013, respectively) in manual compression, compared to Z-stitch group. There was no difference in the proportion of dogs with vascular patency between groups (P=0.59). CONCLUSIONS: Z-stitch and VCD are effective venous hemostasis methods after percutaneous transvenous intervention, with Z-stitch providing the most rapid time-to-hemostasis. Both Z-stitch and VCD techniques have low complication rates and effectively maintain vascular patency.

Transcatheter closure of patent ductus arteriosus in 11 dogs and one cat after incomplete or aborted surgical ligation.

OBJECTIVE: To describe the characteristics and outcomes of transcatheter patent ductus arteriosus (PDA) occlusion after incomplete or aborted surgical ligation in dogs and cats. ANIMALS: Twelve client-owned animals (11 dogs and one cat). MATERIALS AND METHODS: This retrospective study describes data from animals with aborted or incomplete surgical PDA ligation that subsequently underwent transcatheter closure using endovascular methods. Patient demographics, reason for incomplete or aborted surgery, complications, and method of transcatheter occlusion were recorded. Data are presented as mean ± standard deviation or median (interquartile range), where appropriate. RESULTS: For all cases, median age at surgery was 12.2 months (4.9-15.1 months) and at catheterization was 15.4 months (8.9-21.9 months), with 79 days (29-209 days) between surgical and interventional procedures. Median weight at catheterization was 4.5 kg (2.5-12.6 kg). Reasons for failed surgical ligation included hemorrhage during ductal dissection in seven dogs, residual flow in four dogs, and inability to identify the ductus in one cat. Transcatheter closure was successfully performed using a canine duct occluder in eight dogs, transarterial coil embolization in two dogs, and transvenous coil embolization in one dog and one cat. Metallic hemoclips partially obscured angiographic findings in three cases with prior surgical hemorrhage but did not prevent transcatheter closure. In all cases, ductal flow was successfully attenuated, with no or trace residual shunting on angiography and complete occlusion the following day on echocardiography. CONCLUSIONS: When surgery is unsuccessful, either owing to hemorrhage or residual flow, transcatheter closure of PDA is feasible, even in small patients.

A pilot study evaluating cutting and high-pressure balloon valvuloplasty for dysplastic pulmonary valve stenosis in 7 dogs.

INTRODUCTION: This case series describes early experience and technical aspects of cutting balloon dilation followed by high-pressure balloon pulmonary valvuloplasty in dogs with dysplastic pulmonary valve stenosis. ANIMALS: Seven client-owned dogs were enrolled in this study. METHODS: Dogs were prospectively enrolled based on echocardiographic diagnosis of severe pulmonary valve dysplasia, defined as marked valve thickening with variable degrees of annular hypoplasia or subvalvar fibrous obstruction and a peak echocardiography-derived transpulmonary pressure gradient higher than 100 mmHg. Preinterventional and postinterventional hemodynamic data and transthoracic pressure gradients were obtained for all dogs. Recheck echocardiography varied in timing by client convenience, with maximum follow-up 35 months after intervention. RESULTS: No intraprocedural or periprocedural mortality was observed. The only major complication was partial avulsion of a cutting blade related to exceeding recommended burst pressure of the device, which was not associated with obvious clinical consequence. Invasive hemodynamic measurements demonstrated an average reduction of 46% in peak systolic right ventricular-to-pulmonary artery pressure gradient (range, 31-77%). The echocardiographic results 24 h after procedure demonstrated an average reduction in pressure gradient of 43% (range, 20-66%), with late follow-up demonstrating an average reduction of 35% (range, 10-57%) compared with preprocedural echocardiography. CONCLUSIONS: This procedure is a feasible therapeutic transcatheter intervention for dogs with dysplastic pulmonary valves and appears safe in this small cohort. The ideal selection criteria and rate of restenosis for this procedure is under investigation, and long-term follow-up and a large, randomized, controlled study are necessary to demonstrate efficacy.

Effects of Toceranib Phosphate on Systolic Blood Pressure and Proteinuria in Dogs.

BACKGROUND: Systemic hypertension and proteinuria are established adverse effects of tyrosine kinase inhibitor treatment in people. OBJECTIVE: The objective of this study was to investigate changes in systolic blood pressure and the incidence of proteinuria secondary to treatment with toceranib phosphate in dogs with cancer. ANIMALS: Twenty-six control dogs and 30 dogs with cancer were evaluated for the first part of the study (baseline characteristics). For the second part (effect of toceranib phosphate treatment), 48 client-owned dogs were evaluated, including 20 control dogs and 28 dogs with various types of neoplasia. METHODS: Prospective cohort study. Client-owned healthy control dogs and dogs with cancer were enrolled. Blood pressure and urine protein:creatinine ratios were measured before treatment and 2 weeks after initiation of toceranib phosphate treatment. RESULTS: Systolic blood pressure was significantly (P = 0.0013) higher in previously normotensive treatment dogs after initiation of treatment with toceranib phosphate (152 mmHg ± 19) compared to baseline (136 mmHg ± 14). 37% of treated dogs developed SBP ≥ 160 mmHg. The prevalence of systemic hypertension (37%) and proteinuria (21%) at baseline in treatment dogs did not differ from that of age-matched healthy controls (15% [P = 0.13] and 0% [P = 0.069], respectively). CONCLUSIONS AND CLINICAL IMPORTANCE: Toceranib phosphate treatment might result in increased systolic blood pressures in dogs. Systemic hypertension should be considered a potential adverse effect of this drug in dogs. Systemic hypertension and proteinuria were detected at clinically relevant frequencies in the dogs with cancer before antineoplastic therapies suggesting that monitoring of these variables might be warranted in this population.