Comparison of hematologic variables between dogs with congenital intrahepatic and extrahepatic portosystemic shunts.

BACKGROUND: Dogs with congenital intrahepatic portosystemic shunt (IHPSS) are predisposed to gastrointestinal inflammation, ulceration, and bleeding, unlike dogs with congenital extrahepatic portosystemic shunt (EHPSS). Limited information is available about hematologic differences between dogs with IHPSS and dogs with EHPSS. OBJECTIVE: Compare hemogram variables between dogs with IHPSS and EHPSS. We hypothesized that hematologic variables would differ between the 2 populations, with a higher frequency and severity of anemia and microcytosis in dogs with IHPSS. ANIMALS: Twenty-six client-owned dogs with IHPSS and 35 client-owned dogs with EHPSS. METHODS: Retrospective cross-sectional study. Dogs were included if a CBC was performed before shunt attenuation. Contingency analysis was performed to determine if the frequency of clinical signs and of hematologic variables below the reference range differed between groups. Hematologic and selected biochemical variables were compared between groups using an analysis of covariance with age as a covariate. RESULTS: Gastrointestinal clinical signs (IHPSS, 81% vs EHPSS, 34%; P = .01), anemia (31% vs 6%; P = .01), microcytosis (77% vs 29%; P = .002), and hypochromia (77% vs 49%; P = .03) were more common in dogs with IHPSS than in dogs with EHPSS. Dogs with IHPSS had lower packed cell volume (34% vs 41%, P = .04), hemoglobin concentration (11.5 g/dL vs 13.7 g/dL, P = .03), mean corpuscular volume (57 fL vs 65 fL; P = .001), and mean corpuscular hemoglobin concentration (32 g/dL vs 33 g/dL; P = .04) than dogs with EHPSS. CONCLUSIONS AND CLINICAL IMPORTANCE: Dogs with IHPSS had a higher frequency of anemia, microcytosis, and hypochromia and exhibited more gastrointestinal clinical signs.

Enlargement of the hepatic artery is present in dogs with a congenital extrahepatic portosystemic shunt and is independent of shunt insertion into the systemic circulation.

The accurate diagnosis of portovascular anomalies has been facilitated by improvements in diagnostic imaging technology. In humans, hepatic arterial blood flow changes in response to the reduction in portal blood flow. The hepatic arterial buffer response characterizes an intrinsic regulatory mechanism in response to reduced portal venous blood flow, which results in hepatic arterial enlargement. At the authors' institution, enlargement of the hepatic artery has been anecdotally observed in a population of dogs with extrahepatic portosystemic shunting, consistent with previous literature that documents variability in hepatic arterial size. In this retrospective, blinded, analytical study, a hepatic artery:aorta (Ha:Ao) ratio was assessed on CT studies from 112 dogs, with (n = 43) and without (n = 69) an extrahepatic congenital portosystemic shunt in order to compare the hepatic artery size independent of body weight between the two populations. A significant increase in the Ha:Ao ratio was documented in dogs with an extrahepatic portosystemic shunt (EHPSS) compared with those dogs with no EHPSS independent of the location of shunt insertion into the systemic circulation (P < .001). Three cases had repeat CT after surgery, and all had Ha:Ao ratio reductions following treatment. The authors propose that this may be an additional imaging feature observed in dogs with an EHPSS.

Clinical presentation and short-term outcomes of dogs ≥15 kg with extrahepatic portosystemic shunts.

OBJECTIVE: To describe demographics, clinical presentation, shunt anatomy, clinical progression, and complications in large dogs ≥15 kg with single extrahepatic portosystemic shunts (EHPSS) treated with or without surgery. STUDY DESIGN: Multicenter retrospective (10 university hospitals, one private referral institution). ANIMALS: Dogs ≥15 kg (n = 63). METHODS: Medical records of dogs ≥15 kg diagnosed with EHPSS between January 01, 2005 and December 31, 2020 were reviewed. Dogs had a minimum follow-up of 90 days. Signalment, clinical signs, diagnostics, shunt anatomy, treatment interventions, and perioperative complications were assessed. RESULTS: Median age was 21.9 months (IQR: 9-36.8). The breed most represented was the Golden retriever (17/63 dogs). Portocaval (17/63) and splenocaval (15/63) shunt configurations were most common. Portal vein hypoplasia was noted in 18 imaging reports. Of the surgically treated dogs, 14/45 (35.6%) had short-term complications, and 3/45 (6.7%) had shunt-related deaths. Medical management was discontinued in 15/40 and reduced in 9/40 of surviving dogs who had surgical attenuation. All medically managed, nonattenuated dogs (18/18) were maintained on their original shunt-related medication regimens. CONCLUSIONS: Clinical presentation of dogs ≥15 kg with extrahepatic portosystemic shunts was similar to the more commonly reported small breed dogs. Surgical management of single EHPSS in large dogs ≥15 kg had similar clinical short-term outcomes as small breed dogs. CLINICAL SIGNIFICANCE: Clinicians should be aware that large breed dogs with EHPSS share similar characteristics and clinical outcomes to small breed dogs. The significance of the presence of a hypoplastic portal vein warrants further research. Surgical treatment is a viable option for large breed dogs with EHPSS.

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.

Computed tomographic measures of renomegaly vary among dogs with different types of congenital portosystemic shunts.

Renomegaly has been reported in dogs with congenital portosystemic shunts (PSS). However, no study has objectively evaluated the degree of renomegaly in dogs with different types of PSS. The purpose of this retrospective, analytical, cross-sectional study was to determine kidney size (renal length-to-L2 vertebral body ratio; RL/L2 ratio) using CT in dogs with different types of PSS and correlate with clinical information. A medical record search for dogs with a PSS diagnosed using CT between 2016 and 2020 was conducted. Breed, age, sex, body weight, and biochemistry results were recorded. Kidney and L2 vertebral body lengths were measured using multiplanar reformatted CT images, and the RL/L2 ratio was calculated. Dogs were categorized into four groups based on PSS morphology for comparisons: intrahepatic (IH; n = 19), extrahepatic portocaval (EHPC; n = 20), extrahepatic portoazygos (EHPA; n = 7), or extrahepatic portophrenic (EHPP, n = 7). The RL/L2 ratio (mean ± SD) was largest in IH (3.55 ± 0.38) and EHPC (3.55 ± 0.38), followed by EHPP (3.10 ± 0.23), and EHPA (2.78 ± 0.18). RL/L2 ratio was significantly larger in EHPC and IH (vs. EHPA and EHPP [P < .01]). Significant correlations between kidney size and creatinine, alkaline phosphatase, albumin, total protein, and ammonia were present. Renomegaly was observed in 86.8% of dogs with PSS overall, but it was uncommon in dogs with EHPA and less common in dogs with EHPP, as these two groups showed clinical signs later in life, made evident by older age at presentation. The authors suggest that the severity of hepatic dysfunction and the shunted blood volume may influence the development of renomegaly in dogs with PSS.

Urine-based Detection of Congenital Portosystemic Shunt in C57BL/6 Mice.

Sporadic occurrence of congenital portosystemic shunt (PSS) at a rate of ∼1 out of 10 among C57BL/6 J mice, which are widely used in biomedical research, results in aberrancies in serologic, metabolic, and physiologic parameters. Therefore, mice with PSS should be identified as outliers in research. Accordingly, we sought methods to, reliably and efficiently, identify PSS mice. Serum total bile acids ≥ 40 µm is a bona fide biomarker of PSS in mice but utility of this biomarker is limited by its cost and invasiveness, particularly if large numbers of mice are to be screened. This led us to investigate if assay of urine might serve as a simple, inexpensive, noninvasive means of PSS diagnosis. Metabolome profiling uncovered that Krebs cycle intermediates, that is, citrate, α-ketoglutarate, and fumarate, were strikingly and distinctly elevated in the urine of PSS mice. We leveraged the iron-chelating and pH-lowering properties of such metabolites as the basis for 3 urine-based PSS screening tests: urinary iron-chelation assay, pH strip test, and phenol red assay. Our findings demonstrate the feasibility of using these colorimetric assays, whereby their readout can be assessed by direct observation, to diagnose PSS in an inexpensive, rapid, and noninvasive manner. Application of our urinary PSS screening protocols can aid biomedical research by enabling stratification of PSS mice, which, at present, likely confound numerous ongoing studies.

Repeated specific canine pancreatic lipase measurements do not identify multiple acquired portosystemic shunts in dogs after extrahepatic portosystemic shunt attenuation.

BACKGROUND: In dogs with portal hypertension (PH), spec cPL is suggested to be increased despite normal pancreatic histology. After attenuation of congenital extrahepatic portosystemic shunts (cEHPSS), multiple acquired portosystemic shunt (MAPSS) can develop as consequence of sustained PH. Presence of MAPSS affects future therapeutic options and prognosis. OBJECTIVE: Evaluate if spec cPL concentrations increase postoperatively in dogs that develop MAPSS and can thus serve as an indicator of PH. ANIMALS: Twenty-four dogs with cEHPSS. METHODS: Dogs classified according to surgical outcome after cEHPSS attenuation (8 with MAPSS [group M], 9 with closed cEHPSS [group C] and 7 with patent blood flow through the original cEHPSS, without evidence of MAPSS [group P]). Spec cPL was measured in preoperative samples (T0), 4 days (T1) and 1 (T2) and 3- to 6-months (T3) after surgery. RESULTS: Spec cPL was within reference interval (<200 µg/L) at all timepoints except at T1. At T1, 2 dogs in group M (321 and >2000 µg/L) and also 1 in group C (688 µg/L) and 1 in group P (839 µg/L) had increased spec cPL concentrations. No differences in spec cPL concentrations between groups or changes over time were identified. CONCLUSIONS AND CLINICAL IMPORTANCE: Spec cPL is not consistently increased in dogs that develop MAPSS after cEHPSS attenuation and has no potential as a biomarker for the identification of MAPSS after cEHPSS attenuation.

Outcomes in dogs with congenital extrahepatic portosystemic shunts treated with surgical ligation or medical management.

OBJECTIVE: The objective of this study was to evaluate differences in outcomes in dogs treated for extrahepatic portosystemic shunts (EHPSS) by either complete suture ligation, partial suture ligation or medical management. STUDY DESIGN: This wasa retrospective, single institutional study. SAMPLE POPULATION: Dogs (n = 152) with EHPSS treated with suture ligation (n = 62), surgery with no ligation (n = 2), or medical management (n = 88). METHODS: Medical records were reviewed for data on signalment, treatment variables, complications, and outcome. Kaplan-Meier plots were generated to assess survival across groups. Cox's proportional hazard models were used to assess the relationship between survival times and multiple predictor variables. For outcomes of interest, backwards, stepwise regression was performed (p < 0.05). RESULTS: Complete suture ligation was possible in 46/64 (71.9%) of dogs where surgical attenuation was attempted. One dog was euthanized following partial suture ligation due to suspected portal hypertension. Dogs with complete suture ligation of the EHPSS had a significantly longer median survival time (MST) compared to the medical management group (MST not reached vs. 1730 days [p < 0.001]). Complete resolution of clinical signs (without the need for further medical treatment or dietary changes) was achieved in 16/20 (80.0%) dogs with complete suture ligation and 4/10 (40.0%) dogs with partial suture ligation of their EHPSS. CONCLUSION: Suture ligation (complete or partial) for the treatment of EHPSS, where clinically possible, yielded the best clinical outcome and increased longevity compared to medical management in this study. CLINICAL SIGNIFICANCE: While medical management for the treatment of EHPSS in dogs is a valid treatment option, better clinical outcomes are achieved with surgical intervention.

Intramural esophageal location of a portosystemic shunt in a dog with two congenital portosystemic shunts on CT angiography.

A 5-year-old male neutered pug with hematuria was presented to a referral hospital after identification of an extrahepatic portosystemic shunt (EHPSS) during abdominal ultrasonography. Computed tomographic-angiography revealed two anomalous blood vessels (left gastroazygous and left gastrophrenic). The left gastroazygous vessel followed an atypical path within the dorsolateral esophageal wall before entering the azygous vein. The morphology of this highly unusual vessel has not, based on the authors' review of the literature, been previously reported. In combination with a second anomalous vessel, this resulted in a unique presentation of an EHPSS. Computed tomography-angiography was essential for diagnosis and surgical planning in this case.

Dogs with congenital extrahepatic portosystemic shunts that have persistent shunting after surgery have a higher prevalence of urolithiasis.

OBJECTIVE: To report the presence of urolithiasis in dogs long-term after gradual attenuation of congenital extrahepatic portosystemic shunts (cEHPSS). ANIMALS: 25 client-owned dogs that underwent gradual attenuation of a cEHPSS, of which 19 had a closed cEHPSS and 6 developed multiple acquired portosystemic shunts (MAPSS) following surgery. PROCEDURES: A retrospective study with prospective follow-up was performed. Dogs that underwent cEHPSS surgery and had their postoperative cEHPSS status determined by transsplenic portal scintigraphy or CT angiography 3 months postoperatively were prospectively contacted and invited for a long-term follow-up visit (a minimum of 6 months postoperatively). Retrospective data were collected, and during the prospective follow-up visit a thorough history, blood tests and urinalysis, and ultrasonography of the urinary tract were performed to assess the presence of urinary signs and urolithiasis. RESULTS: Of 25 included dogs, 1 of 19 (5%) dogs with closed cEHPSS and 4 of 6 (67%) dogs with MAPSS had urolithiasis at long-term follow-up. Three (50%) dogs with MAPSS developed new uroliths. Long-term, dogs with closed cEHPSS that initially presented with and without urolithiasis had significantly less urolithiasis compared to dogs with MAPSS (P = .013 and P = .010, respectively). In the 4 dogs with closed cEHPSS that initially presented with nephrolithiasis, nephroliths became smaller or were no longer visible at the long-term follow-up visit. CLINICAL RELEVANCE: Dogs that developed MAPSS following cEHPSS surgery are at greater risk of urolithiasis compared to those with closed cEHPSS. Furthermore, ammonium urate uroliths might dissolve if portosystemic shunting ceases to exist.

Unique case of pelvic congestion syndrome caused by a new communication branch of the portal-vena cava system.

Congenital portosystemic shunt (CPS) is a developmental anomaly of the portal vein system. The disease can cause blood from the portal vein to flow into the vena cava, resulting in various atypical clinical manifestations. Pelvic congestion syndrome (PCS) caused by CPS is particularly rare. A young woman with PCS had an abnormal communicating branch of the left ovarian vein (OV). Her left OV drained normally into the left renal vein, and at the same time communicated with the portal vein, forming an extrahepatic portosystemic shunt. With embolization of her left OV, the patient was cured of PCS.

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.

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.

Postattenuation neurologic signs after surgical correction of congenital portosystemic shunts in cats: A narrative review.

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.

Congenital portopulmonary shunt in a cat.

A 9-year-old spayed female crossbreed cat with chief complaints of anorexia and hypersalivation had high serum concentrations of ammonia and fasting and postprandial total bile acid. Therefore, she was referred to our hospital. On the first evaluation, haematology, serum chemistry, radiography and ultrasonography findings suggested that she had a congenital portosystemic shunt. CT revealed a shunt vessel from the left gastric vein to the left pulmonary vein. During median celiotomy and sternotomy, gross findings and mesenteric portography revealed abnormal vessel shunting from the left gastric vein to the left pulmonary vein. Complete ligation of the shunt vessel was achieved. She recovered without any complications. Postoperative serum chemistry revealed that ammonia and total bile acid levels decreased to within the reference intervals. This report is the first to describe the clinical features and surgical outcome of a cat with a congenital portopulmonary shunt.

Short- and long-term outcomes of polyethylene band attenuation of congenital extrahepatic portosystemic shunts in dogs: 60 cases (2010-2020).

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.

Percutaneous transvenous coil embolization of congenital intrahepatic portosystemic shunts in small- and toy-breed dogs: 20 cases (2015-2021).

OBJECTIVE: To describe outcomes of small- and toy-breed dogs with a congenital intrahepatic portosystemic shunt (IHPSS) treated with percutaneous transvenous coil embolization (PTCE). ANIMALS: 20 small- and toy-breed dogs with an IHPSS. PROCEDURES: All dogs underwent CT angiography for shunt evaluation as well as PTCE. Medical records were reviewed for pertinent data, and owners and primary veterinarians were contacted for long-term follow-up information. RESULTS: Dogs ranged from 1.5 to 10.0 kg (mean ± SD, 6.32 ± 2.57 kg) in weight. The equipment used to perform PTCE tended to be smaller than that previously described for larger breed dogs. Intra- and postoperative complication rates were 20% (4/20) and 5% (1/20), respectively, and included hypotension, bradycardia, hypercapnia, ventricular premature contractions, hypothermia, and regurgitation. Dogs were discharged a median of 3 days (range, 1 to 3 days) after surgery, and all dogs survived to discharge. Clinical signs resolved in 95% (19/20) of the dogs a median of 21 days after the procedure. One- and 2-year survival rates were 92%. Three dogs had died by the time of data collection; 2 of these dogs died of causes related to the IHPSS 267 and 1,178 days, respectively, after the procedure. CLINICAL RELEVANCE: Percutaneous transvenous coil embolization was a safe and effective option for treatment of IHPSS in small- and toy-breed dogs and offered a minimally invasive alternative to open surgical techniques. Complication and survival rates in this cohort were similar to or better than those reported in previous studies evaluating PTCE and open surgical techniques for treatment of IHPSS in dogs.

Surgical treatment and outcome of intrahepatic shunts in 12 cats.

CASE SERIES SUMMARY: The objective of this case series was to describe the presentation, surgical treatment and outcome of a congenital intrahepatic portosystemic shunt (IHPSS) in 12 cats. A retrospective case series of cats undergoing surgical treatment for an IHPSS was undertaken. Signalment, clinical signs, imaging, surgical treatment, complications and short-term outcome (<30 days) were obtained using medical records. Long-term outcome (>1 year after first surgery) was obtained, where possible, using a health-related quality of life owner questionnaire. Seven cats were diagnosed with a left divisional shunt, three with a central divisional shunt and two with a right divisional shunt using intraoperative mesenteric portovenography. Three cats tolerated complete acute suture attenuation, eight cats underwent partial suture attenuation, four of which received complete suture ligation at a second surgery, and one cat underwent partial attenuation with a thin film band. Six cats (50%) developed post-attenuation neurological signs (PANS) after first surgery and two cats (17%) died or were euthanased due to severe PANS. Long-term outcome was available for eight cats (67%), with a median follow-up time of 1743 days (range 364-2228), and was described as excellent in five cats (63%), fair in two cats (25%) and poor in one cat (12%). RELEVANCE AND NOVEL INFORMATION: Few papers exist that describe the presentation, intraoperative imaging, treatment and outcome of IHPSSs in cats. This is the first to describe surgical attenuation with a thin film band in a cat with an IHPSS. This case series reports excellent long-term outcomes in a majority of surgically treated cats with IHPSS.

Comparison of diet, lactulose, and metronidazole combinations in the control of pre-surgical clinical signs in dogs with congenital extrahepatic portosystemic shunts.

BACKGROUND: Hepatic supportive diet (HSD), lactulose, and antimicrobials are medical treatments for dogs with congenital extrahepatic portosystemic shunts (cEHPSS). The relative contribution of these treatment components is currently unknown. OBJECTIVES: To determine which treatment combinations are most efficacious in pre-surgical control of clinical signs of cEHPSS in dogs. ANIMALS: Thirty-six dogs with untreated cEHPSS. METHODS: Three-arm randomized clinical trial. At inclusion (T0), dogs were divided into 3 groups: HSD (n = 12), HSD + lactulose (n = 12), or HSD + metronidazole (n = 12) and received the randomized treatment for 4 weeks (T1) followed by combined treatment of HSD + lactulose + metronidazole for 2 weeks or until cEHPSS attenuation (T2). Clinical score as well as fasting ammonia (FA) and C-reactive protein (CRP) concentrations were compared among groups and time points. RESULTS: Thirty-four dogs were evaluated. Thirty-four dogs reached T1 and 29 dogs T2. At T1, clinical scores decreased in the HSD + lactulose (n = 11; P = .001), but not in the HSD (n = 8; P = .96) and HSD + metronidazole (n = 10; P = .06) groups. Adding metronidazole to HSD + lactulose (n = 11) did not result in further clinical score improvement (T2; P = 1.000). Moderate and weak correlation between clinical score and FA and clinical score and CRP was present (ρ = .35, P < .001; ρ = .27, P = .01, respectively) with FA decreasing over time on medical treatment (P = .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Combined HSD + lactulose seems sufficient for pre-surgical cEHPSS stabilization unlike sole HSD or HSD + metronidazole. Medical treatment of cEHPSS clinical signs decreases FA.

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.

Laparoscopic portosystemic shunt attenuation in 20 dogs (2018-2021).

OBJECTIVE: To describe the technique, complications, and outcome of laparoscopic portosystemic shunt attenuation (LPSSA) in dogs. STUDY DESIGN: Retrospective study. ANIMALS: Twenty client-owned dogs. METHODS: Medical records were searched for dogs with a single congenital extrahepatic portosystemic shunt (CEPSS) that was treated with LPSSA. Signalment, clinical signs, CEPSS location, diagnostic imaging, laparoscopic approach, operative technique, complications, and clinical outcome were reviewed. RESULTS: Fourteen dogs with CEPSS located in the epiploic foramen had a right (13/14) or left (1/14) paramedian approach. In 6 dogs a CEPSS was not located in the epiploic foramen, and a left paramedian approach was used. A 3 or 4-port technique was used in 7 and 13 dogs, respectively. A thin film band was used for CEPSS attenuation in all dogs. The median operating time for LPSSA was 62 min (range 27-98 min). Intraoperative complications requiring conversion to an open technique occurred in 5 dogs. Mild perioperative self-limiting portal hypertension occurred in 3 dogs, while severe portal hypertension with surgical revision occurred in 1 case. The complications were resolved, and all dogs had a good outcome. CONCLUSION: Laparoscopic portosystemic shunt attenuation can be performed in dogs, in particular for a CEPSS located in the epiploic foramen using a right paramedian approach. For CEPSS not located in the epiploic foramen, a left paramedian approach is recommended. Conversion to open celiotomy was required in around a third of cases. CLINICAL SIGNIFICANCE: Laparoscopic attenuation of CEPSSs can be performed in dogs and has a good clinical outcome, particularly for CEPSS located in the epiploic foramen.