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Outcome associated with use of a percutaneously controlled hydraulic occluder for treatment of dogs with intrahepatic portosystemic shunts

Christopher A. AdinDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.

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Colin W. SeredaDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.

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Margaret S. ThompsonDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.

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Jason L. WheelerDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.

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Linda L. ArcherDepartment of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.

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Abstract

Objective—To evaluate efficacy of a hydraulic occluder (HO) used for treatment of dogs with an intrahepatic portosystemic shunt (IHPSS).

Design—Prospective study.

Animals—10 dogs with an IHPSS.

Procedures—Serum biochemical and postprandial bile acids (PPBA) analyses and transcolonic scintigraphy were performed before surgery. Laparotomy was performed, and an uninflated HO was placed around the portal vein branch leading to the IHPSS. After surgery, 0.9% NaCl solution was injected into subcutaneous injection ports at 2, 4, 6, and 8 weeks to achieve staged occlusion of the HO. Serum biochemical analyses, PPBA analysis, and scintigraphy were performed 2 weeks after occlusion. Serum biochemical analyses were repeated 1 year after surgery.

Results—Implant revision was required in 3 dogs because of rupture of the HO (n = 2) or detachment of the actuating tubing (1). Serum biochemical values and clinical signs improved in all dogs after surgery. Six of 10 dogs had PPBA concentration within reference range 2 weeks after occlusion, and 2 additional dogs had concentrations within reference range at 1 year. Only 5 of 10 dogs had complete resolution of portosystemic shunting 2 weeks after occlusion. Two dogs were lost to follow-up, and 8 dogs remained alive with no recurrence of clinical signs at a median of 22 months after surgery.

Conclusions and Clinical Relevance—Use of the HO appeared to be an effective method for surgical treatment for dogs with IHPSS, although problems with implant reliability indicate a need for modifications in design and manufacturing.

Abstract

Objective—To evaluate efficacy of a hydraulic occluder (HO) used for treatment of dogs with an intrahepatic portosystemic shunt (IHPSS).

Design—Prospective study.

Animals—10 dogs with an IHPSS.

Procedures—Serum biochemical and postprandial bile acids (PPBA) analyses and transcolonic scintigraphy were performed before surgery. Laparotomy was performed, and an uninflated HO was placed around the portal vein branch leading to the IHPSS. After surgery, 0.9% NaCl solution was injected into subcutaneous injection ports at 2, 4, 6, and 8 weeks to achieve staged occlusion of the HO. Serum biochemical analyses, PPBA analysis, and scintigraphy were performed 2 weeks after occlusion. Serum biochemical analyses were repeated 1 year after surgery.

Results—Implant revision was required in 3 dogs because of rupture of the HO (n = 2) or detachment of the actuating tubing (1). Serum biochemical values and clinical signs improved in all dogs after surgery. Six of 10 dogs had PPBA concentration within reference range 2 weeks after occlusion, and 2 additional dogs had concentrations within reference range at 1 year. Only 5 of 10 dogs had complete resolution of portosystemic shunting 2 weeks after occlusion. Two dogs were lost to follow-up, and 8 dogs remained alive with no recurrence of clinical signs at a median of 22 months after surgery.

Conclusions and Clinical Relevance—Use of the HO appeared to be an effective method for surgical treatment for dogs with IHPSS, although problems with implant reliability indicate a need for modifications in design and manufacturing.

Contributor Notes

Dr. Adin's present address is Veterinary Specialists of Rochester, 825 White Spruce Blvd, Rochester, NY 14623.

Dr. Thompson's present address is Department of Clinical Sciernces, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853.

Dr. Wheeler's present address is Wheat Ridge Animal Hospital, 3695 Kipling St, Wheat Ridge, CO 80033.

Supported by a grant from the Morris Animal Foundation

Presented in abstract form at the 2005 American College of Veterinary Surgeons Veterinary Symposium, San Diego, October 2005.

Address correspondence to Dr. Adin.