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Evaluation of a Portocaval Venograft and Ameroid Ring for the Occlusion of Intrahepatic Portocaval Shunts in Dogs
Author(s) -
Kyles Andrew E.,
Gregory Clare R.,
Jackson Joshua,
Ilkiw Janet E.,
Pascoe Peter J.,
Adin Christopher,
Samii Valerie F.,
Herrgesell Eric
Publication year - 2001
Publication title -
veterinary surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.652
H-Index - 79
eISSN - 1532-950X
pISSN - 0161-3499
DOI - 10.1053/jvet.2001.20333
Subject(s) - medicine , occlusion , portography , surgery , portal venous pressure , portal hypertension , portacaval shunt , portosystemic shunt , ascites , cirrhosis
Objective— To evaluate the use of a portocaval venograft and ameroid constrictor in the surgical management of intrahepatic portosystemic shunts (PSS). Study Design— Prospective, clinical study. Animal Population— Ten client‐owned dogs with intrahepatic PSS. Methods— Portal pressure was measured after temporary suture occlusion of the intrahepatic PSS. In dogs with an increase in portal pressure greater than 8 mm Hg, a single extrahepatic portocaval shunt was created using a jugular vein. An ameroid ring was placed around the venograft and the intrahepatic PSS was attenuated. Transcolonic pertechnetate scintigraphy was performed before surgery, 5 days after surgery, and 8 to 10 weeks after surgery. Dogs with continued portosystemic shunting were evaluated further by laparotomy or portography. Clinical outcome and complications were recorded. Results— Mean (± SD) portal pressure increased from 6 ± 3 to 19 ± 6 mm Hg with PSS occlusion; in all 10 dogs, the increase in portal pressure was greater than 8 mm Hg. There were no intraoperative complications, and, after creation of the portocaval shunt, the intrahepatic PSS could be completely ligated in 8 of 10 dogs. The final portal pressure was 9 ± 4 mm Hg. Postoperative complications included coagulopathy and death (1 dog), ascites (3 dogs), and incisional discharge (3 dogs). Five of 8 dogs had continued portosystemic shunting at 8 to 10 weeks after surgery. Multiple extrahepatic PSS were demonstrated in 4 of these dogs. Clinical outcome was excellent in all 9 surviving dogs. Conclusions and Clinical Significance— The surgical technique resulted in a high incidence of multiple extrahepatic PSS. Short‐term clinical results were promising, but long‐term outcome must be evaluated further.