Slow occlusion of portosystemic shunts using a variety of methods is being evaluated world wide. Cellophane banding is a relatively simple procedure with comparable safety and efficacy to previously reported techniques.
Determination of factors that predict the outcome after surgical treatment of CPS in dogs is important to gain insight in treatment selection or new therapeutic options.
Objective: To report the incidence of postattenuation seizures (PAS) in dogs that underwent single congenital extrahepatic portosystemic shunt (cEHPSS) attenuation and to compare incidence of PAS in dogs that either did or did not receive prophylactic treatment with levetiracetam (LEV). Study design: Multi-institutional retrospective study. Population: Nine hundred forty dogs. Methods: Medical records were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 2005 through July 2017 and developed PAS within 7 days postoperatively. Dogs were divided into 3 groups: no LEV (LEV−); LEV at ≥15 mg/kg every 8 hours for ≥24 hours preoperatively or a 60 mg/kg intravenous loading dose perioperatively, followed by ≥15 mg/kg every 8 hours postoperatively (LEV1); and LEV at <15 mg/kg every 8 hours, for <24 hours preoperatively, or continued at <15 mg/kg every 8 hours postoperatively (LEV2).Preliminary results of this study were presented at the Association
Objective: To identify prognostic factors for short-term survival of dogs that experienced seizures within seven days following surgical correction of single congenital extrahepatic portosystemic shunts (cEHPSS).Study Design: Multi-institutional retrospective study.
Sample Population: Ninety-three client-owned dogs. Methods: Medical records at 14 veterinary institutions were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 1 st 2005 through February 28 th 2018 and experienced post-attenuation seizures (PAS) within seven days postoperatively. Logistic regression analysis was performed to identify factors associated with one month survival. Factors investigated included participating institution, signalment, shunt morphology, concurrent/historical conditions, presence of preoperative neurologic signs, presence of preoperative seizures, aspects of preoperative medical management, surgical details including method and degree of shunt attenuation, type of PAS (focal only or generalized +/-focal), drugs administered as part of the treatment of PAS, and development of complications during treatment of PAS. Results: Thirty (32.3%) dogs survived to 30 days. Seventy-six (81.7%) dogs experienced generalized PAS. Factors positively associated with short-term survival included having a history of preoperative seizures (p=0.004) and development of focal PAS only (p=0.0003).The majority of non-survivors were humanely euthanized due to uncontrolled or recurrent seizures.Conclusions: Dogs that experienced PAS that had a history of preoperative seizures and those that experienced focal PAS only had significantly improved short-term survival.
Clinical Significance:The results of this study will help in the counseling of owners who seek treatment for PAS following surgical correction of cEHPSS.
Background: In dogs with congenital portosystemic shunts (CPSS), the ability of the hypoplastic liver to grow is considered important for recovery after surgical shunt attenuation.Objectives: This study investigated hepatic growth after extrahepatic shunt attenuation in dogs using magnetic resonance imaging (MRI) and computed tomography (CT).Animals: Ten client-owned dogs with single extrahepatic CPSS. Methods: Abdominal MRI, CT, or both were performed before and 8 days, 1, and 2 months after shunt attenuation. Liver volumes were calculated from the areas of the MRI or CT images.Results: Before surgery, median liver volume was 18.2 cm 3 /kg body weight. Liver volume increased significantly after surgery. Growth was highest between days 0 and 8 and decreased afterward. Median liver volume was 28.8 cm 3 /kg at 2 months after attenuation. No significant differences in growth were found between dogs with complete or partial shunt closure or between dogs with complete or incomplete metabolic recovery. Volumes measured from consecutively performed MRI and CT images correlated well (r 5 0.980), but volumes from MRI images were significantly larger than volumes from CT images (6.8%; P 5 .008).Conclusion and Clinical Importance: After shunt attenuation, rapid normalization of liver size was observed. Hepatic growth was not decreased in dogs after partial closure of CPSS or in dogs with subclinical, persistent shunting 2 months after surgery. CT is the preferred imaging method for volumetric estimation because of speed.
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