A 6-year-old 17-kg (37.4-lb) spayed female mixed-breed dog was evaluated because of swelling and intermittent lameness of the right pelvic limb and perianal and vulvar bleeding caused by a suspected arteriovenous malformation.
The right pelvic limb had a diffuse, raised, cobblestone-like appearance with lameness, edema, and multifocal ulcerations. The abdominal skin had multifocal circular erythematous lesions, the perianal region was erythematous, and the vestibule had superficial distended vessels. Ultrasonography and CT did not reveal the presence of an arteriovenous malformation; however, digital subtraction venography confirmed the presence of a venous malformation (VM) throughout the limb.
TREATMENT AND OUTCOME
A mixture of foam sclerosant (1.5% sodium tetradecyl sulfate) and contrast medium was agitated with air and injected percutaneously into the VM. The dog received an injection of corticosteroid solution, and a soft-padded bandage was applied to the limb for 3 days. Six weeks later, the dog would intermittently hop when running, and the limb was mildly edematous with ecchymotic lesions; the swelling and lameness had improved considerably. Perianal and vulvar bleeding and dilation of the vestibular vessels had resolved. At 21 months after the procedure, examination revealed no right pelvic limb lameness related to the VM; only small cyst-like lesions and edema around the tarsus remained.
The favorable clinical outcome for this dog for a 21-month period after treatment of a pelvic limb VM with foam sclerotherapy has suggested that foam sclerotherapy may be used to successfully treat limb VMs in some dogs.
CASE DESCRIPTION Two Pembroke Welsh Corgis with gastrointestinal signs including inappetence, diarrhea, lethargy, and hypersalivation were referred for evaluation.
CLINICAL FINDINGS Diagnostic testing included abdominal ultrasonography and CT angiography. One patient had a cranial mesenteric artery-to-mesenteric vein fistula with multiple acquired extrahepatic portosystemic shunts. The second patient had both cranial and caudal mesenteric artery-to-mesenteric vein fistulas and multiple acquired extrahepatic portosystemic shunts.
TREATMENT AND OUTCOME Both patients underwent minimally invasive coil embolization of the mesenteric arterioportal fistulas, with complete occlusion confirmed by means of angiography at procedure completion. Clinical outcome approximately 1 year after treatment was assessed as fair to good because of recurrence of clinical signs that required medical management in 1 dog and some persistent serum biochemical abnormalities.
CLINICAL RELEVANCE Outcome for the 2 patients described suggested that coil embolization may be a feasible and effective minimally invasive technique for the treatment of mesenteric arterioportal fistulas in dogs. However, further investigation of the potential for chronic hepatic disease in patients with a history of acquired portosystemic shunts is warranted.