Use of Transsplenic Injection of Agitated Saline and Heparinized Blood for the Ultrasonographic Diagnosis of Macroscopic Portosystemic Shunts in Dogs

Abstract

We describe the use of ultrasonography-guided percutaneous splenic injection of agitated saline and heparinized blood for the diagnosis of portosystemic shunts (PSS) in 34 dogs. Agitated saline mixed with 1 ml of heparinized autologous blood was injected into the spleen of 34 sedated dogs under sonographic guidance. The transducer was then sequentially repositioned to visualize the portal vein, the caudal vena cava, and the right atrium through different acoustic windows. It was possible to differentiate between intrahepatic and extrahepatic shunts depending on the entry point of the microbubbles into the caudal vena cava. Portoazygos shunts and portocaval shunts could be differentiated based on the presence of microbubbles in the caudal vena cava and/or the right atrium. In one dog, collateral circulation due to portal hypertension was identified. In dogs with a single extrahepatic shunt, the microbubbles helped identify the shunting vessel. The technique was also used postoperatively to assess the efficacy of shunt closure. All abnormal vessels were confirmed by exploratory laparotomy or with ultrasonographic identification of the shunting vessel. Ultrasound-guided transsplenic injection of agitated saline with heparinized blood should be considered as a valuable technique for the diagnosis of PSS; it is easy to perform, safe, and the results are easily reproducible. r

Ultrasound Guided Transarterial Coil Placement in the Internal and External Carotid Artery in Horses

“…Ultrasound‐guided injection of 0.9% saline solution is used for ultrasonographic diagnosis in human and veterinary medicine. This technique is easy to perform, safe, and the results are easily reproducible . To our knowledge, there are no previous reports describing the efficacy of this technique to test vascular occlusion, therefore should be compared in further studies to the use of contrast product.…”

Surgical management of an extrahepatic portosystemic shunt in a foal: A multidisciplinary problem

“…Gomez‐Ochoa et al . () mapped the microbubbles within the portal vein, the PSS, the hepatic veins and the caudal vena cava thus differentiating extra‐ and intrahepatic PSS and portoazygous PSS.…”

Liver

“…273 Other methods have been reported to aid in the ultrasound diagnosis of portosystemic shunts. 305 Transvenous coil embolization, surgical ligation, and placement of other external occlusion devices have been used to treat congenital intrahepatic or solitary extrahepatic portacaval shunts in dogs. 304 In a follow-up study, agitated saline mixed with heparinized autologous blood was injected into the splenic pulp and followed through the portal vein, caudal vena cava, and right atrium to identify the presence of both intrahepatic and extrahepatic shunts and determine the effectiveness of postoperative shunt closure.…”