Surgical treatment of intrahepatic portosystemic shunts in six cats

Abstract

The surgical treatment of intrahepatic portosystemic shunts in six cats is described. The preoperative diagnoses were based on the results of abdominal ultrasonography, and mesenteric portography was used during surgery to confirm the diagnosis and establish the morphology of the shunting vessel. In four of the cats the shunt vessel passed through the left division of the liver, compatible with a patent ductus venosus (PDV), in one cat the shunt passed through the central hepatic division and in the other cat it passed through the right hepatic division. During surgery the shunt vessel was manipulated directly either intrahepatically, or post hepatically in the four cats with PDV. In five cats the shunt vessel was partially ligated, and in the other the vessel was completely ligated. The attenuation procedure produced a mean increase in mesenteric venous pressure of 17 cm H2O, with a range from 14 to 20 cm. All the cats recovered from the surgical procedure, but one developed neurological signs shortly after the operation and died from respiratory failure. Four of the cats were clinically normal and required no medication by one month after the operation. One cat required long-term medication to control its continued clinical signs.

Association of mesenteric portovenographic findings with outcome in cats receiving surgical treatment for single congenital portosystemic shunts

“…The prevalence of postattenuation neurologic complications in cats in this study (60%) was higher than that in other reports, 6,[18][19][20][21][22] including that of a retrospective study 14 from our institution in which postattenuation neurologic complications affected 18 of 49 (37%) cats. This difference may reflect our increasing awareness of the wide spectrum of neurologic signs that can be detected following surgery, combined with our increased tendency to actively look for and treat even the mildest signs of postattenuation neurologic complications.…”

“…6,14,17 A mesenteric vein was catheterized for measurement of portal venous blood pressure and IMP before and after temporary complete occlusion of the CPSS with a Rummel tourniquet. A second surgery, approximately 12 weeks after the first, was the recommended treatment of choice for all cats that initially underwent partial attenuation of a CPSS.…”

“…6,9 The mesenteric vein was catheterized with the largest bore catheter possible (20 or 22 gauge), and a bolus of 1 mL of iodinated contrast medium b /kg (1.0 mg/kg [0.45 mg/lb]) was injected as quickly as possible into a mesenteric vein for each portovenogram. 6,9 The mesenteric vein was catheterized with the largest bore catheter possible (20 or 22 gauge), and a bolus of 1 mL of iodinated contrast medium b /kg (1.0 mg/kg [0.45 mg/lb]) was injected as quickly as possible into a mesenteric vein for each portovenogram.…”

Evaluation of ameroid ring constrictors for the management of single extrahepatic portosystemic shunts in cats: 23 cases (1996–2001)

“…The follow-up, however, was limited to cats treated with an ARC, excluding the cat with the ligated PSS. Intrahepatic PSS, multiple extrahepatic PSS, and portal atresia have been reported in cats 2,10,12,16,27 ; therefore, cats with these conditions were excluded.…”

“…2 There are sporadic reports and case series of PSS in cats in the veterinary literature. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Single extrahepatic portocaval shunts are reported to be the most common type of PSS in cats. 19 In a review of 11 clinical studies reporting a total of 40 cats with PSS, all had single PSS, and most (79%) were extrahepatic.…”