Use of endovascular stents in three dogs with Budd-Chiari syndrome

Michael D. Schlicksup Veterinary Hospital, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

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Chick W. Weisse Veterinary Hospital, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

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Allyson C. Berent Veterinary Hospital, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

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Jeffrey A. Solomon Section of Vascular and Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA 19104.

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Abstract

Case Description—3 dogs were examined because of Budd-Chiari syndrome (BCS), which is an obstruction of venous blood flow located between the liver and the junction of the caudal vena cava and right atrium. Two dogs had confirmed neoplastic obstructions, and the other dog had a suspected neoplastic obstruction of the hepatic veins and caudal vena cava.

Clinical Findings—All dogs had similar clinical signs of weight gain, lethargy, and ascites that did not respond to medical treatments, and 2 dogs had pitting edema of the hind limbs. Ultrasonography revealed a presumptive venous obstruction, which was confirmed by use of computed tomography.

Treatment and Outcome—Each dog was anesthetized. By use of fluoroscopic guidance, endovascular stents were placed within the left hepatic vein and caudal vena cava in 2 dogs, and a single stent was placed within the left hepatic vein extending into the caudal vena cava of the third dog. After stent placement, venous pressure in the left hepatic vein decreased. Resolution of clinical signs was dramatic in all 3 dogs (survival time ranged from 7 to 20 months), with only mild complications in 1 dog.

Clinical Relevance—Endovascular stents may be an appropriate palliative treatment for dogs with clinical signs attributable to BCS.

Abstract

Case Description—3 dogs were examined because of Budd-Chiari syndrome (BCS), which is an obstruction of venous blood flow located between the liver and the junction of the caudal vena cava and right atrium. Two dogs had confirmed neoplastic obstructions, and the other dog had a suspected neoplastic obstruction of the hepatic veins and caudal vena cava.

Clinical Findings—All dogs had similar clinical signs of weight gain, lethargy, and ascites that did not respond to medical treatments, and 2 dogs had pitting edema of the hind limbs. Ultrasonography revealed a presumptive venous obstruction, which was confirmed by use of computed tomography.

Treatment and Outcome—Each dog was anesthetized. By use of fluoroscopic guidance, endovascular stents were placed within the left hepatic vein and caudal vena cava in 2 dogs, and a single stent was placed within the left hepatic vein extending into the caudal vena cava of the third dog. After stent placement, venous pressure in the left hepatic vein decreased. Resolution of clinical signs was dramatic in all 3 dogs (survival time ranged from 7 to 20 months), with only mild complications in 1 dog.

Clinical Relevance—Endovascular stents may be an appropriate palliative treatment for dogs with clinical signs attributable to BCS.

  • 1.

    Aydinli M, Bayraktar Y. Budd-Chiari syndrome: etiology, pathogenesis and diagnosis. World J Gastroenterol 2007;13:26932696.

  • 2.

    Okuda K, Kage M, Shrestha SM. Proposal of a new nomenclature for Budd-Chiari syndrome: hepatic vein thrombosis versus thrombosis of the inferior vena cava at its hepatic portion. Hepatology 1998;28:11911198.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Bayraktar UD, Seren S, Bayraktar Y. Hepatic venous outflow obstruction: three similar syndromes. World J Gastroenterol 2007;13:19121927.

  • 4.

    Fine DM, Olivier NB, Walshaw R, et al. Surgical correction of late-onset Budd-Chiari-like syndrome in a dog. J Am Vet Med Assoc 1998;212:835837.

    • Search Google Scholar
    • Export Citation
  • 5.

    Miller MW, Bonagura JD, DiBartola SP, et al. Budd-Chiari-like syndrome in two dogs. J Am Anim Hosp Assoc 1989;25:277283.

  • 6.

    Haskal ZJ, Dumbleton SA, Holt D. Percutaneous treatment of caval obstruction and Budd-Chiari syndrome in a cat. J Vasc Interv Radiol 1999;10:487489.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Qiao T, Liu CJ, Liu C, et al. Interventional endovascular treatment for Budd-Chiari syndrome with long-term follow-up. Swiss Med Wkly 2005;135:318326.

    • Search Google Scholar
    • Export Citation
  • 8.

    Valla DC. The diagnosis and management of the Budd-Chiari syndrome: consensus and controversies. Hepatology 2003;38:793803.

  • 9.

    Kyles AE, Feldman EC, De Cock HE, et al. Surgical management of adrenal gland tumors with and without associated tumor thrombi in dogs: 40 cases (1994–2001). J Am Vet Med Assoc 2003;223:654662.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Rollois M, Ruel Y, Besso JG. Passive liver congestion associated with caudal vena caval compression due to oesophageal leiomyoma. J Small Anim Pract 2003;44:460463.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Saridomichelakis MN, Koutinas CK, Souftas V, et al. Extensive caudal vena cava thrombosis secondary to unilateral renal tubular cell carcinoma in a dog. J Small Anim Pract 2004;45:108112.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Whelan MF, O'Toole TE, Carlson KR, et al. Budd-Chiari-like syndrome in a dog with a chondrosarcoma of the thoracic wall. J Vet Emerg Crit Care 2007;17:175178.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Jaffe MH, Grooters AM, Partington BP, et al. Extensive venous thrombosis and hind-limb edema associated with adrenocortical carcinoma in a dog. J Am Anim Hosp Assoc 1999;35:306310.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    LeGrange SN, Fossum TW, Lemire T, et al. Thrombosis of the caudal vena cava presenting as an unusual cause of an abdominal mass and thrombocytopenia in a dog. J Am Anim Hosp Assoc 2000;36:143151.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Brewster DC, Athanasoulis CA, Darling RC. Leiomyosarcoma of the inferior vena cava. Arch Surg 1976;111:10811085.

  • 16.

    Hartley JW, Awrich AE, Wong J, et al. Diagnosis and treatment of the inferior vena cava syndrome in advanced malignant disease. Am J Surg 1986;152:7074.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Brountzos EN, Binkert CA, Panagiotou IE, et al. Clinical outcome after intrahepatic venous stent placement for malignant inferior vena cava syndrome. Cardiovasc Intervent Radiol 2004;27:129136.

    • Search Google Scholar
    • Export Citation
  • 18.

    Charnsangavej C, Carrasco CH, Wallace S, et al. Stenosis of the vena cava: preliminary assessment of treatment with expandable metallic stents. Radiology 1986;161:295298.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Irving JD, Dondelinger RF, Reidy JF, et al. Gianturco self-expanding stents: clinical experience in the vena cava and large veins. Cardiovasc Intervent Radiol 1992;15:328333.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Raju S, Hollis K, Neglen P. Obstructive lesions of the inferior vena cava: clinical features and endovenous treatment. J Vasc Surg 2006;44:820827.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Oudkerk M, Heystraten FM, Stoter G. Stenting in malignant vena caval obstruction. Cancer 1993;71:142146.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Klein AS. Management of Budd-Chiari syndrome. Liver Transpl 2006;12(suppl 2):S23S28.

  • 23.

    Chunqing Z, Lina F, Guoquan Z, et al. Ultrasonically guided percutaneous transhepatic hepatic vein stent placement for Budd-Chiari syndrome. J Vasc Interv Radiol 1999;10:933940.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Orloff MJ, Baddeley RM, Ross TH, et al. Experimental ascites. V. Production of hepatic outflow block and ascites with a hepatic vein choker. Ann Surg 1965;161:258262.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Zamora CA, Sugimoto K, Mori T, et al. Use of the wallstent for symptomatic relief of malignant inferior vena cava obstructions. Radiat Med 2005;23:380385.

    • Search Google Scholar
    • Export Citation
  • 26.

    Wright KC, Wallace S, Charnsangavej C, et al. Percutaneous endovascular stents: an experimental evaluation. Radiology 1985;156:6972.

  • 27.

    O'Sullivan GJ, Lohan DA, Cronin CG, et al. Stent implantation across the ostia of the renal veins does not necessarily cause renal impairment when treating inferior vena cava occlusion. J Vasc Interv Radiol 2007;18:905908.

    • Crossref
    • Search Google Scholar
    • Export Citation

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