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.

Clinical outcomes for 20 cats with congenital extrahepatic portosystemic shunts treated with ameroid constrictor ring attenuation (2002-2020).

OBJECTIVE: To report the clinical perioperative, short-term, and long-term outcomes for cats undergoing ameroid ring constrictor (ARC) attenuation of a congenital extrahepatic portosystemic shunt (EHPSS). STUDY DESIGN: Retrospective case series from a single veterinary teaching hospital (2002-2020). ANIMALS: Twenty client-owned cats with EHPSS. METHODS: Data collected from medical records included signalment, history, physical examination, clinicopathologic testing, medications, diagnostic imaging, intraoperative findings, perioperative complications, and postoperative clinical outcomes. Long-term clinical outcome was obtained from a standardized owner interview or medical records. RESULTS: Perioperative complications were reported in five cats out of 20, including blindness (two cats), ascites (one cat), head pressing (one cat), and seizures and death (one cat). Short-term clinical outcome was excellent in 14/18 cats, good in 2/18 cats, and poor in 2/18 cats that were available for follow up, and long term clinical outcome was excellent in 15/18, good in 1/18 cats, and poor in 2/18 cats that were available for follow up. CONCLUSION: Long-term clinical outcome was good or excellent in 16/18 of cats available for follow up. Perioperative complications were reported in five cats. CLINICAL SIGNIFICANCE: Surgical attenuation of EHPSS with an ARC can result in resolution of clinical signs and biochemical abnormalities in the majority of cats. The perioperative complication rate for feline patients with EHPSS attenuated with an ARC was lower than reported historically. Seizures may persist in the long term despite normal bile acid stimulation test results, complete blood count, and biochemistry analysis.

Single center retrospective clinical audit and comparison of outcome between epicardial and transvenous endocardial permanent pacemaker implantations in dogs.

The aim of this retrospective cohort study was to provide a single-center clinical audit of complications for single chamber permanent pacemaker implantation (PPI) techniques and determine if the clinical parameters, PPI technique or complications were associated with outcome. The electronic medical records were searched for dogs treated for bradyarrhythmia with PPI. Data related to presenting complaint, signalment of the dog, ECG diagnosis, echocardiographic findings, PPI technique, and programing of the pacemaker were recorded. Survival length (days) was recorded as the last veterinary visit; if the dog was dead the reason was documented. Cumulative survival of each pacemaker was examined by a Kaplan-Meier survival curve and the two techniques compared with a logrank test. Chi-square was used to determine the association between major complications and death. A total of 66 dogs with 52 transvenous and 30 epicardial PPIs were included. All epicardial pacemakers were implanted via transdiaphragmatic approach. A total of 31 life-threatening complications were reported. There were nine deaths related to major complications (13.6% of the study sample). The median follow-up period was 366 days, with a median survival of 255 days, and a significant difference in cumulative survival of each pacemaker (P = 0.01) between epicardial (93 days, range 0-1882 days) and transvenous (334 days, range 0-2745) PPIs but no significant difference in cumulative survival between the two techniques when only the first pacemaker was considered (p = 0.07). The presence of a major complications had a significant association with death due to pacemaker complications (P<0.001). The decision to perform epicardial PPI in failed transvenous PPI patients may have skewed the cumulative survival as was evident in the lack of significant difference in survival when only first PPI were examined. Major complication rates between the two techniques were similar and the authors consider both techniques equally reliable to manage symptomatic bradycardia in dogs.

Local wound management: A review of modern techniques and products.

Management of wounds is a commonly performed and essential aspect of small animal veterinary medicine. Appropriate wound management is a difficult art to master, due to the inherent complexity of the clinical scenario, as well as the ever-evolving nature of the field with the constant addition of new products and techniques. This article reviews key concepts that may help the practitioner better understand the natural process of wound healing, factors that delay healing and strategies to help improve the local wound environment to make it more conducive to healing during open wound management. The concept of wound bed preparation is defined before common local wound management strategies, such as wound lavage and debridement, are discussed in more detail. Key aspects of the management of biofilms and appropriate use of antimicrobial agents are also reviewed. Finally, the concept of moist wound healing and its impact in modern wound management is explained before a broad variety of types of wound dressings are reviewed, with a particular focus on active dressings.

La prise en charge des plaies est un aspect courant et essentiel de la médecine vétérinaire pour petits animaux. La gestion appropriée des plaies est un art difficile à maîtriser, en raison de la complexité inhérente du scénario clinique, ainsi que de la nature en constante évolution du domaine avec l'ajout constant de nouveaux produits et techniques. Cet article passe en revue les concepts clés qui peuvent aider le praticien à mieux comprendre le processus naturel de cicatrisation des plaies, les facteurs qui retardent la cicatrisation et les stratégies pour aider à améliorer l'environnement local de la plaie afin de le rendre plus propice à la cicatrisation lors de la gestion des plaies ouvertes. Le concept de préparation du lit de la plaie est défini avant que les stratégies locales courantes de gestion des plaies, telles que le lavage et le débridement de la plaie, ne soient discutées plus en détail. Les principaux aspects de la gestion des biofilms et de l'utilisation appropriée des agents antimicrobiens sont également passés en revue. Enfin, le concept de cicatrisation humide et son impact dans la prise en charge moderne des plaies sont expliqués avant de passer en revue une grande variété de types de pansements, avec un accent particulier sur les pansements actifs.

El manejo de heridas es un aspecto esencial y comúnmente realizado de la medicina veterinaria de pequeños animales. El manejo adecuado de heridas es un arte difícil de dominar, debido a la complejidad inherente del escenario clínico, así como a la naturaleza en constante evolución de este campo con la adición constante de nuevos productos y técnicas. Este artículo revisa los conceptos clave que pueden ayudar al médico a comprender mejor el proceso natural de cicatrización de heridas, los factores que retrasan la cicatrización y las estrategias para ayudar a mejorar el entorno local de la herida para que sea más propicio para la cicatrización durante el tratamiento de heridas abiertas. El concepto de preparación del lecho de la herida se define antes de que se analicen con más detalle las estrategias comunes de tratamiento local de la herida, como el lavado y el debridamiento de la herida. También se revisan aspectos clave del manejo de biopelículas y el uso adecuado de agentes antimicrobianos. Finalmente, se explica el concepto de cicatrización húmeda de heridas y su impacto en el tratamiento moderno de heridas antes de revisar una amplia variedad de tipos de apósitos para heridas, con un enfoque particular en los apósitos activos.

Manejo de feridas é um procedimento essencial comumente realizado na medicina veterinária de pequenos animais. Um manejo de feridas adequado é uma arte difícil de se aperfeiçoar, devido à sua complexidade inerente ao cenário clínico, bem como à natureza em constante evolução da área com a adição contínua de novas técnicas e produtos. Este artigo revisa os conceitos mais importantes que podem ajudar o clínico a compreender melhor o processo natural de cicatrização de feridas, fatores que atrasam e estratégias que melhoram o ambiente local da ferida para torná-la mais predisposta à cicatrização durante o manejo de feridas abertas. O conceito de preparação do leito da ferida deve ser definido antes da discussão mais detalhada das estratégias de manejo mais comuns, como lavagem e debridamento. Aspectos chave do manejo de biofilmes e uso apropriado de antimicrobianos também foram revisados. Finalmente, o conceito de cicatrização úmida de feridas e o seu impacto no manejo de feridas moderno é explicado antes da revisão de diversos tipos de curativos oclusivos, com um foco particular nos curativos ativos.

Traumatic stifle injury in 72 cats: a multicentre retrospective study.

OBJECTIVES: The aim of the study was to describe traumatic stifle injury in cats and report complications and long-term outcome. METHODS: The medical records from seven veterinary hospitals of cats treated for traumatic stifle injury were reviewed. Long-term follow-up data were collected from referring veterinarians and using the Feline Musculoskeletal Pain Index, collected from owners. RESULTS: Seventy-two cats were included in the study. The most common combination of ligament injury involved both cruciate ligaments and the lateral collateral ligament (25.4%). Medial meniscal injury was more common (66.2%) than lateral meniscal injury (59.4%). A temporary transarticular pin was used intraoperatively to aid reduction in 23/73 (31.5%) surgeries. Postoperative immobilisation was applied in 41/72 (56.9%) cats with a mean duration of 4.8 weeks. Short-term complications occurred in 40/64 (62.5%) cats. Long-term complications occurred in seven (17.5%) cats. Overall outcome was excellent in 25/61 (41%) cats, good in 13/61 (21.3%) cats, fair in 11/61 (18%) cats and poor in 12/61 (19.7%) cats. Mean length of follow-up was 29.6 months (range 0.5-204). A significantly poorer outcome was observed in cats with medial meniscal injury and those undergoing revision surgery. Use of a transarticular pin when left in situ for postoperative immobilisation was associated with a poorer outcome (P = 0.043) and a higher risk of complications (P = 0.018). Postoperative immobilisation was not related to outcome. CONCLUSIONS AND RELEVANCE: Traumatic stifle injury in cats can lead to rupture of multiple ligaments causing significant instability of the joint. Surgical treatment is associated with a high rate of short-term complications, although long-term outcome may still be good to excellent in the majority of cats (62.3%). In cats where follow-up was available, postoperative immobilisation had no positive effect on outcome and may not be required. Leaving a transarticular pin for postoperative immobilisation is not recommended as it was significantly associated with a poorer outcome and a higher complication rate.

Repeatability and accuracy of a novel, quantitative radiographic method for differentiating normal canine sacroiliac joints from joints with subluxation or luxation: Pilot study.

Canine sacroiliac (SI) joint subluxation or luxation is most commonly diagnosed based on qualitative radiographic assessments. Aims of this two-part, retrospective, diagnostic accuracy, pilot study were to develop and evaluate a novel quantitative method based on measuring the angle between a line connecting the iliac wings and parallel lines across three anatomical landmarks (cranial endplate of L7, caudal endplate of L6, cranial endplate of L6) on a single ventrodorsal radiograph. For the first part of the study, angle measurements from a single observer were compared for 20 normal canine pelvic radiographs and 20 pelvic radiographs with SI luxation or subluxation. Mean values significantly differed between datasets (P < 0.001). The angles for the normal pelves ranged from 0.6° to 1.5°, while abnormal angles ranged from 3.8° to 7.1°. For the second part of the study, a dataset of 25 normal and 25 abnormal canine pelvic radiographs was evaluated using the novel technique by three blinded readers with varying levels of expertise at two different time points. There was excellent reliability among the three readers with an intraclass correlation (ICC) value of 0.90 and an excellent agreement between day 0 and day 30 readings with an ICC value of 0.91. It was also determined that a cut-off angle of 2.0°, using the line parallel to the cranial endplate of L6, provided overall the best accuracy, sensitivity, and specificity to differentiate normal versus abnormal pelves. These findings may be helpful for clinical cases with equivocal diagnoses and for future development of automated diagnostic tools.

Mechanical comparison of loop and crimp configurations for extracapsular stabilization of the cranial cruciate ligament-deficient stifle.

OBJECTIVE: To biomechanically compare different loop and crimp configurations used for extracapsular suture stabilization of the CCL-deficient stifle. STUDY DESIGN: In vitro study. SAMPLE POPULATION: Crimped loop constructs of 100 lb Ande type nylon leader line in 7 different configurations comprising single and double loops, single and double crimps, and the interlocking loop configuration. METHODS: Constructs premade on external skeletal fixator bars 60 mm apart and tested in tension with a custom-made split circular arm mounted on a table-top materials testing machine. Data were derived from force/displacement plots. In "load to failure" test (10/group) constructs were loaded to failure with distraction rates of 10 mm/min; ultimate load, tension at 2 mm elongation and failure were recorded. In "staircase" test (5/group) constructs cycled at 100 N/s from 75 N with incremental increases of 50 N/cycle; ultimate load, maximum tension before elongation at rest over 2 mm and failure were recorded. In "cycling and jumping" test (10/group) 3 of 7 constructs cycled at 100 N/s 100 times from 50 to 100 N, then 5 times from 50 to 600 N; failure and elongation at cycles 1, 50 and 100 and at jumps 1 to 5 recorded. RESULTS: Double-loop double-crimp configurations were statistically superior to all other configurations in ultimate load, and to single-loop and interlocking loop configurations in elongation in "load to failure" and "staircase" tests. In "cycling and jumping" test the interlocking loop configuration specimens elongated significantly more than the others and only in the double-loop double-crimp group did all constructs complete the test. CONCLUSIONS: Double-loop double-crimp configurations are mechanically superior to other previously described configurations.