Percutaneous transvenous coil embolization of portosystemic shunts
A congenital portosystemic shunt (PSS) is a vascular anomaly connecting the portal venous system with the central venous system, allowing nutrient-rich blood to bypass the liver, avoid detoxification and enter the systemic circulatory system, leading to a variety of biochemical and clinical sequellae. See how a minimally invasive procedure helped this puppy.
Initial treatment decisions
After an intrahepatic PSS was diagnosed, a medical regimen was recommended to reduce the clinical signs associated with the hepatic dysfunction and gastrointestinal upset, including lactulose (dosed to produce soft but formed bowel movements), metronidazole (7.5 mg/kg b.i.d.), omeprazole (1 mg/kg b.i.d.) and a low-protein diet compatible with liver disease. The patient was discharged with instructions to return in about one month for CT angiography. The delay in further imaging was done to maximize the patient's medical regimen in order to reduce any potential risks associated with general anesthesia.
CT angiography and treatment options
The patient returned one month later with reports that it had dramatically improved on these medications. It had gained 4.5 kg and was having no further neurologic or ataxic episodes. A dual-phase CT angiogram was performed, which demonstrated a large, left divisional intrahepatic PSS. Portal perfusion to the liver was substantially diminished, and the liver was small. The kidneys were mildly enlarged with mild renal pelvic mineralization or nephrolithiasis.
Medical, surgical and interventional management was discussed with the owners. Understanding that medical management would likely be temporary and concerned about the risk associated with traditional open surgery, the owners opted for a minimally invasive approach using percutaneous transvenous coil embolization.