Prospective evaluation of outcome of dogs with intrahepatic portosystemic shunts treated via percutaneous transvenous coil embolization

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Abstract

Objective: To report outcome and complications after percutaneous transvenous coil embolization (PTCE) and evaluate the clinical, laboratory, and imaging changes in dogs with intrahepatic portosystemic shunts (IHPSS) pre-PTCE and post-PTCE. Study design: Prospective clinical trial. Animals: Twenty-five dogs (15 dogs in imaging subgroup) with IHPSS. Methods: Clinical signs, hematologic, and biochemical parameters were recorded before and 3 months after PTCE. All dogs received the same medical treatment and underwent PTCE. In the imaging subgroup, ultrasonography, hepatic portal scintigraphy, and computed tomography-angiography were performed pre-PTCE and post-PTCE. Results: All evaluated bloodwork values improved by at least 50% of their initial value, by 3 months post-PTCE. Liver volume increased after PTCE (P =.001), but remained lower than normal in 11/15 dogs. Hepatic arterial fraction decreased after PTCE (P =.029), consistent with increased portal blood flow to the liver. Twenty-four of 25 dogs were available for reevaluation at 3 months, and all abnormal clinical signs had resolved in 22/24 dogs. Conclusion: PTCE appears promising as a treatment for IHPSS, as clinical signs resolved in most cases, bloodwork abnormalities often normalized, and the procedure was performed safely with minimal complications. PTCE increased hepatic portal perfusion and liver volume in most dogs. These promising results justify a future randomized clinical trial comparing PTCE, other attenuation options, and medical management alone.

Original languageEnglish (US)
Pages (from-to)74-85
Number of pages12
JournalVeterinary Surgery
Volume47
Issue number1
DOIs
StatePublished - Jan 1 2018

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Surgical Portasystemic Shunt
Dogs
dogs
liver
Liver
image analysis
scintigraphy
randomized clinical trials
medical treatment
prospective studies
computed tomography
Radionuclide Imaging
ultrasonography
blood flow
Ultrasonography
Randomized Controlled Trials
Perfusion
experimental design
Clinical Trials
Prospective Studies

ASJC Scopus subject areas

  • veterinary(all)

Cite this

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title = "Prospective evaluation of outcome of dogs with intrahepatic portosystemic shunts treated via percutaneous transvenous coil embolization",
abstract = "Objective: To report outcome and complications after percutaneous transvenous coil embolization (PTCE) and evaluate the clinical, laboratory, and imaging changes in dogs with intrahepatic portosystemic shunts (IHPSS) pre-PTCE and post-PTCE. Study design: Prospective clinical trial. Animals: Twenty-five dogs (15 dogs in imaging subgroup) with IHPSS. Methods: Clinical signs, hematologic, and biochemical parameters were recorded before and 3 months after PTCE. All dogs received the same medical treatment and underwent PTCE. In the imaging subgroup, ultrasonography, hepatic portal scintigraphy, and computed tomography-angiography were performed pre-PTCE and post-PTCE. Results: All evaluated bloodwork values improved by at least 50{\%} of their initial value, by 3 months post-PTCE. Liver volume increased after PTCE (P =.001), but remained lower than normal in 11/15 dogs. Hepatic arterial fraction decreased after PTCE (P =.029), consistent with increased portal blood flow to the liver. Twenty-four of 25 dogs were available for reevaluation at 3 months, and all abnormal clinical signs had resolved in 22/24 dogs. Conclusion: PTCE appears promising as a treatment for IHPSS, as clinical signs resolved in most cases, bloodwork abnormalities often normalized, and the procedure was performed safely with minimal complications. PTCE increased hepatic portal perfusion and liver volume in most dogs. These promising results justify a future randomized clinical trial comparing PTCE, other attenuation options, and medical management alone.",
author = "Culp, {William T} and Allison Zwingenberger and Michelle Giuffrida and Wisner, {Erik R} and Hunt, {Geraldine B} and Steffey, {Michele A} and Philipp Mayhew and Marks, {Stanley L}",
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T1 - Prospective evaluation of outcome of dogs with intrahepatic portosystemic shunts treated via percutaneous transvenous coil embolization

AU - Culp, William T

AU - Zwingenberger, Allison

AU - Giuffrida, Michelle

AU - Wisner, Erik R

AU - Hunt, Geraldine B

AU - Steffey, Michele A

AU - Mayhew, Philipp

AU - Marks, Stanley L

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N2 - Objective: To report outcome and complications after percutaneous transvenous coil embolization (PTCE) and evaluate the clinical, laboratory, and imaging changes in dogs with intrahepatic portosystemic shunts (IHPSS) pre-PTCE and post-PTCE. Study design: Prospective clinical trial. Animals: Twenty-five dogs (15 dogs in imaging subgroup) with IHPSS. Methods: Clinical signs, hematologic, and biochemical parameters were recorded before and 3 months after PTCE. All dogs received the same medical treatment and underwent PTCE. In the imaging subgroup, ultrasonography, hepatic portal scintigraphy, and computed tomography-angiography were performed pre-PTCE and post-PTCE. Results: All evaluated bloodwork values improved by at least 50% of their initial value, by 3 months post-PTCE. Liver volume increased after PTCE (P =.001), but remained lower than normal in 11/15 dogs. Hepatic arterial fraction decreased after PTCE (P =.029), consistent with increased portal blood flow to the liver. Twenty-four of 25 dogs were available for reevaluation at 3 months, and all abnormal clinical signs had resolved in 22/24 dogs. Conclusion: PTCE appears promising as a treatment for IHPSS, as clinical signs resolved in most cases, bloodwork abnormalities often normalized, and the procedure was performed safely with minimal complications. PTCE increased hepatic portal perfusion and liver volume in most dogs. These promising results justify a future randomized clinical trial comparing PTCE, other attenuation options, and medical management alone.

AB - Objective: To report outcome and complications after percutaneous transvenous coil embolization (PTCE) and evaluate the clinical, laboratory, and imaging changes in dogs with intrahepatic portosystemic shunts (IHPSS) pre-PTCE and post-PTCE. Study design: Prospective clinical trial. Animals: Twenty-five dogs (15 dogs in imaging subgroup) with IHPSS. Methods: Clinical signs, hematologic, and biochemical parameters were recorded before and 3 months after PTCE. All dogs received the same medical treatment and underwent PTCE. In the imaging subgroup, ultrasonography, hepatic portal scintigraphy, and computed tomography-angiography were performed pre-PTCE and post-PTCE. Results: All evaluated bloodwork values improved by at least 50% of their initial value, by 3 months post-PTCE. Liver volume increased after PTCE (P =.001), but remained lower than normal in 11/15 dogs. Hepatic arterial fraction decreased after PTCE (P =.029), consistent with increased portal blood flow to the liver. Twenty-four of 25 dogs were available for reevaluation at 3 months, and all abnormal clinical signs had resolved in 22/24 dogs. Conclusion: PTCE appears promising as a treatment for IHPSS, as clinical signs resolved in most cases, bloodwork abnormalities often normalized, and the procedure was performed safely with minimal complications. PTCE increased hepatic portal perfusion and liver volume in most dogs. These promising results justify a future randomized clinical trial comparing PTCE, other attenuation options, and medical management alone.

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