Long‐term clinical outcomes of dogs with single congenital extrahepatic portosystemic shunts attenuated with thin film banding or ameroid ring constrictors

Abstract

Objective To compare long‐term clinical outcomes of dogs with single congenital extrahepatic portosystemic shunts (CEHPSS) treated with thin film banding (TFB) consisting of polyolefin fiber or ameroid ring constrictor (ARC) placement in dogs. Design Retrospective, two‐center clinical study. Animals Client‐owned dogs (n = 123) with single CEHPSS undergoing gradual attenuation via TFB (n = 85) or ARC (n = 38). Methods Medical records of dogs with CEHPSS were reviewed. Follow‐up data were collected from the referring veterinarian and/or owner via standardized questionnaire. Data were analyzed to compare short‐term mortality rate and long‐term outcome (>6 months). Results Dogs in the TFB group were older than dogs in the ARC group (median age, 19 vs 12 months, respectively; P = .01). There was no difference in survival to discharge between dogs in the TFB (81/85 [95.3%]) and ARC (37/38 [97.4%]; P > .99) groups. Preoperative levetiracetam was more frequently administered to dogs treated with TFB (64/85 [75.3%]) than to dogs treated with ARC (15/38 [39.5%;] P = .0002). Postoperative seizures were reported in 10 (8.1%) dogs; their prevalence did not differ between dogs treated with TFB (9/85 [10.6%]) and dogs treated with ARC (1/38 [2.6%]; P = .17). Median follow‐up time for dogs treated with TFB (58.0 months, range 8‐130) and ARC (63.3 months, range 7‐138; P = .24) did not differ. Conclusion Gradual attenuation of a single CEHPSS with either TFB or ARC resulted in similar long‐term clinical outcomes and low postoperative morbidity and mortality rates. Clinical significance Thin film banding (polyolefin fiber) offers an alternative leading to clinical outcomes similar to ARC in dogs with single CEHPSS.

Feasibility of thoracoscopic attenuation of the azygos vein as a model for portoazygos shunts: A canine cadaveric study

“…Thus, surgeons may experience more challenges related to the small body size of dogs with PA shunts compared with those encountered in this cadaveric study. Nonetheless, the median body weight of cadavers in this study (7.7 kg) was similar to the median body weights reported in other studies of dogs with CEPSS (range, 4.5‐6.5 kg) 7,21‐23 . In our study, the only modifications required to faclititate device placement in smaller cadavers consisted of removing the cannulas and using the 5‐mm right‐angle forceps to place the ameroid key.…”

“…Nonetheless, the median body weight of cadavers in this study (7.7 kg) was similar to the median body weights reported in other studies of dogs with CEPSS (range, 4.5-6.5 kg). 7,[21][22][23] In our study, the only modifications required to faclititate device placement in smaller cadavers consisted of removing the cannulas and using the 5-mm right-angle forceps to place the ameroid key. With the exception of the 10-mm right-angle forceps and the 12-mm endoscopic clip applicator, 5-mm instruments were used to isolate the azygos vein and place the attenuation devices.…”

Postattenuation neurologic signs after surgical attenuation of congenital portosystemic shunts in dogs: A review

“…Most published reports include only dogs affected by PAS, 1,2,4,[6][7][8][9]12,16,17,[23][24][25][26][27][29][30][31][32][33][34][35][37][38][39][40]42,[45][46][47][48][49] but others include dogs that manifest any form of PANS. 5,10,11,[13][14][15][18][19][20][21][22]28,36,41,43,44,50 Within the latter reports, 5,10,11,…”

“…However, investigators in two of these studies do not report specific timing of neurologic signs prior to surgery. 13,48 Absence of preoperative neurologic signs/HE (prior to medical management or immediately preoperatively) does not exclude the possibility of PANS. 39,41,47 In a study that included 93 dogs affected by PAS, 47 approximately 25% of affected dogs did not have preoperative neurologic signs and only 17.2% had preoperative seizures.…”

“…46 A limitation of all published studies describing prophylactic treatment with levetiracetam is their retrospective nature and lack of randomization and standardization of treatment. 34,39,41,[46][47][48] Some studies provide no information regarding preoperative or postoperative dose or duration of levetiracetam. 39,48 In the study by Fryer and colleagues, 34 some dogs did not receive any postoperative levetiracetam, with the authors placing emphasis on pretreatment.…”