Long‐term serum bile acid concentrations in 51 dogs after complete extrahepatic congenital portosystemic shunt ligation

Bristow, Poppy; Tivers, Michael; Packer, Rowena M. A.; Brockman, Daniel J.; Ortiz, Victor; Newson, K.; Lipscomb, Victoria

doi:10.1111/jsap.12685

Cited by 27 publications

(48 citation statements)

References 28 publications

(34 reference statements)

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“…It was recently shown that persistent mild increases in pre-and post-prandial bile acids exist despite resolution of clinical signs in dogs treated for extrahepatic CPSS. 32 However, a relatively large proportion of dogs in the TFB group in our study required revision surgery and this would be considered a failure of the initial surgery. The requirement for routine biochemical follow-up and further surgical intervention in dogs with an apparently good outcome but evidence of persistent shunting remains unclear.…”

Section: Discussionmentioning

confidence: 87%

Outcomes of dogs treated for extrahepatic congenital portosystemic shunts with thin film banding or ameroid ring constrictor

2019

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Objective: To compare the outcomes of dogs treated for single extrahepatic congenital portosystemic shunts (CPSS) by thin film banding (TFB) or placement of an ameroid constrictor (AC) at a single institution. Study design: Retrospective case series. Animals: 76 client owned dogs with CPSS treated with TFB (n=53) or AC (n=23). Methods: Records were reviewed for signalment, pre-, intra-and postoperative management and short-term outcomes. Data on second surgeries were reviewed. Long-term outcomes were obtained by use of an owner-directed health related quality of life questionnaire. The rates of complications, mortality, and revision surgery were compared between the treatment groups. Results: Postoperative complications occurred in 15 dogs with TFB (28%) (9% mortality, n=5) and 8 with AC (35%) (4% mortality, n=1) dogs. Long-term follow up was available in 41/56 dogs at a median of 53 (15-88) months. Revision surgery for persistent shunting was performed in 14 (29%) dogs treated initially with TFB, and no dogs treated initially with AC (P=0.007). Median long-term outcome scores were good in both groups. 9/14 revision surgeries led to favorable outcomes. Conclusions: Persistent shunting requiring revision surgery was more common when CPSS were treated with TFB than AC but both treatments achieved favorable long-term outcomes. Clinical significance: Treatment of CPPS by placement of an AC rather than a TFB seems more reliable for shunt attenuation and prevention of revision surgeries.

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Section: Discussionmentioning

confidence: 87%

Outcomes of dogs treated for extrahepatic congenital portosystemic shunts with thin film banding or ameroid ring constrictor

2019

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“…Measurement of fasting blood ammonia concentration is therefore the testing method of choice for diagnosing portosystemic shunting after surgery. An additional ammonia tolerance test or ultrasonography could rule out portosystemic shunting completely . Although also a reliable technique, shunt fractions, using scintigraphy, were not measured in our study because of invasiveness and cost.…”

Section: Discussionmentioning

confidence: 95%

Genome‐wide based model predicting recovery from portosystemic shunting after liver shunt attenuation in dogs

Bossche

Steenbeek

Weber

et al. 2018

Veterinary Internal Medicne

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BackgroundIn dogs with congenital portosystemic shunt (CPSS), recovery after surgical CPSS attenuation is difficult to predict.ObjectivesOur aim was to build a model with plasma albumin concentration and mRNA expression levels of hepatic gene products as predictors of recovery from portosystemic shunting after surgery.AnimalsSeventy‐three client‐owned dogs referred for surgical attenuation of CPSS.MethodsA prediction model was constructed using 2 case‐control studies of recovered and nonrecovered dogs after surgical CPSS attenuation. In the 1st study, a dog‐specific gene expression microarray analysis was used to compare mRNA expression in intraoperatively collected liver tissue between 23 recovered and 23 nonrecovered dogs. In the 2nd study, preoperative plasma albumin concentration and the expression of microarray‐selected genes were confirmed by RT‐qPCR in intraoperatively collected liver samples of 31 recovered and 31 nonrecovered dogs, including 35 dogs from the 1st study.ResultsIn the 1st study, 43 genes were differently expressed in recovered and nonrecovered dogs. The mean preoperative plasma albumin concentration in recovered dogs was higher compared to nonrecovered dogs (23 and 19 g/L, respectively; P = .004). The best fitting prediction model in the 2nd study included preoperative plasma albumin concentration and intraoperative DHDH, ERLEC1, and LYSMD2 gene expression levels.Conclusion and Clinical ImportanceA preclinical model was constructed using preoperative plasma albumin concentration and intraoperative hepatic mRNA expression of 3 genes that were unbiasedly selected from the genome to predict recovery from portosystemic shunting after shunt ligation. Further development is essential for clinical application.

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“…The finding of a lack of return to “normal” fits with studies assessing other outcome measures, for example, serum bile acid concentrations have been shown to not return to within reference intervals in the long‐term in the majority of dogs with a complete shunt attenuation (Bristow et al . ). It is suggested that some dogs have continued microvascular shunting following CPSS surgery due to concurrent microvascular dysplasia or primary portal vein hypoplasia (O'Leary et al .…”

Section: Discussionmentioning

confidence: 97%

“…Most studies assessing biochemical parameters as an outcome measure do not show a return to normal reference values (Lawrence et al 1992, Hunt & Hughes , Bristow et al . ), although those assessing owner opinion on outcome do show an apparent return to a “normal” quality of life (QoL). However, for this latter long‐term outcome, most studies use a simple form of owner assessment based on the resolution of clinical signs and whether the dog receives ongoing medical management (Smith et al .…”

Section: Introductionmentioning

confidence: 99%

“…The current available reports have examined various techniques and different clinical variables to assess the outcome and success; including liver function tests (ammonia, bile acids), imaging to detect persistent shunting (scintigraphy and ultrasound) and owner assessment (Smith et al 1995, White et al 1998, Hunt & Hughes 1999, Hunt 2004, Kummeling et al 2004, Frankel et al 2006, Mehl et al 2007, Falls et al 2013, Greenhalgh et al 2014, Weisse et al 2014, Winkler et al 2014. Most studies assessing biochemical parameters as an outcome measure do not show a return to normal reference values (Lawrence et al 1992, Hunt & Hughes 1999, Bristow et al 2017, although those assessing owner opinion on outcome do show an apparent return to a "normal" quality of life (QoL). However, for this latter long-term outcome, most studies use a simple form of owner assessment based on the resolution of clinical signs and whether the dog receives ongoing medical management (Smith et al 1995, Mehl et al 2007, Falls et al 2013, Greenhalgh et al 2014, Weisse et al 2014.…”

Section: Introductionmentioning

confidence: 99%

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Health‐related quality of life following surgical attenuation of congenital portosystemic shunts versus healthy controls

Bristow

Lipscomb

Kummeling

et al. 2018

J of Small Animal Practice

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Objectives To design a health‐related quality of life questionnaire for dogs with congenital portosystemic shunts, use it in a cohort of dogs treated with suture attenuation and compare results with those obtained from a healthy control cohort. Materials and Methods Data were collected from the hospital records of dogs treated with suture ligation of an intrahepatic or extrahepatic congenital portosystemic shunt at two referral centres. Owners were asked to complete a questionnaire assessing their dog's health‐related quality of life preoperatively (retrospectively) and at the time of follow‐up. Owners of control dogs also completed the questionnaire. Results One hundred and twenty‐eight dogs with congenital portosystemic shunts and 131 control dogs were recruited. Median follow‐up time was 64 months (range 19.7 to 157.2). The median long‐term health‐related quality of life score was excellent for both intrahepatic and extrahpatic shunt cases and similar to that of control dogs. The long‐term portosystemic shunt clinical sign scores for both intrahepatic and extrahepatic congenital portosystemic shunt dogs were significantly worse than the those of the control group. Clinical Significance Suture attenuation of congenitial portosystemic shunts is associated with an excellent health‐related quality of life score at long‐term follow‐up.

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Long‐term serum bile acid concentrations in 51 dogs after complete extrahepatic congenital portosystemic shunt ligation

Abstract: The results suggest that in dogs treated with complete suture ligation mild increases in serum bile acids are not clinically relevant if there are no physical examination abnormalities, a normal body condition score and no relapse in clinical signs.

Cited by 27 publications

References 28 publications

Outcomes of dogs treated for extrahepatic congenital portosystemic shunts with thin film banding or ameroid ring constrictor

Outcomes of dogs treated for extrahepatic congenital portosystemic shunts with thin film banding or ameroid ring constrictor

Genome‐wide based model predicting recovery from portosystemic shunting after liver shunt attenuation in dogs

Health‐related quality of life following surgical attenuation of congenital portosystemic shunts versus healthy controls

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