Current Concepts in Congenital Portosystemic Shunts

Mankin, Kelley M. Thieman

doi:10.1016/j.cvsm.2015.01.008

Cited by 24 publications

(22 citation statements)

References 43 publications

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“…If the stomach is subsequently retracted cranially, the portal vein and its tributaries may be identified running within the dorsal leaf of the omentum. Abnormal shunting vessels may be identified and, if applicable, traced to their communication site with the prehepatic CVC . In the current study, this approach to the prehepatic CVC and the epiploic foramen was not used or required; all shunts entering the prehepatic CVC at the level of the epiploic foramen were located and attenuated using the mesoduodenum as a mesenteric ‘dam’, as described.…”

Section: Discussionmentioning

confidence: 98%

“…Surgical intervention to close a shunting vessel is considered the definitive treatment for dogs and cats with a congenital portosystemic shunt (PSS) . A number of surgical procedures have been described for closure of a congenital PSS and these can be divided broadly into either open techniques or minimally invasive vascular interventional techniques . With either approach, it is often not safe to induce an acute complete occlusion of the shunt because of the development of a life‐threatening portal hypertension .…”

mentioning

confidence: 99%

“…[1][2][3] A number of surgical procedures have been described for closure of a congenital PSS and these can be divided broadly into either open techniques or minimally invasive vascular interventional techniques. [4][5][6] With either approach, it is often not safe to induce an acute complete occlusion of the shunt because of the development of a life-threatening portal hypertension. 7 At open surgery, therefore, it is frequently the case that the shunt is only partially closed using a ligature, an ameroid constrictor, a cellophane band or hydraulic occluder, all of which are placed around the shunt to induce its gradual occlusion during the postoperative period.…”

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confidence: 99%

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Implications of shunt morphology for the surgical management of extrahepatic portosystemic shunts

2018

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Objective To describe the implications of extrahepatic portosystemic shunt morphology for the chosen site of shunt closure in dogs and cats. Methods A retrospective review of a consecutive series of dogs and cats managed for congenital extrahepatic portosystemic shunts. Results In total, 54 dogs and 10 cats met the inclusion criteria, revealing five distinct shunt types: left gastrophrenic, right gastrocaval (types Ai, Aii and Aiii), splenocaval, colocaval and left gastro‐azygos. Without exception, findings of computed tomography angiography and direct gross observations at the time of surgery confirmed four consistent sites of communication between the anomalous shunting vessel and the systemic venous system: the caudal vena cava at the level of the epiploic foramen; the left phrenic vein at the level of the oesophageal hiatus; the azygos vein at the level of the aortic hiatus; and the caudal vena cava or iliac vein at the level of the 6th or 7th lumbar vertebrae. The use of intraoperative mesenteric portography was effective for confirming that at the time of surgery all portal tributary vessels were proximal to the point of shunt attenuation. Conclusions Findings confirmed that for the common types of extrahepatic portosystemic shunts there were only four consistent sites of communication between the shunt and the systemic venous system. This information supports the use of a systematic approach for the location and attenuation of shunts in dogs and cats.

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

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Implications of shunt morphology for the surgical management of extrahepatic portosystemic shunts

2018

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“…Não se sabe a causa da anemia microcítica, estudos sugerem uma deficiência no transporte de ferro, diminuição da concentração de ferro e aumento do depósito de ferro nas células de Kupffer. No hemograma, pode-se encontrar leucocitose, que pode estar associado com escape de endotoxinas ou bactérias do sistema porta por DPS (Berent & Tobias, 2009;Mankin, 2015).…”

Section: Fístula Arteriovenosa Hepática Em Cão: Relato De Casounclassified

Fístula Arteriovenosa Hepática Em Cão: Relato De Caso

Isidoro¹,

Oliveira²,

Lopes³

et al. 2017

BJVM

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RELATO DE CASOCopyright Isidoro et al. Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution Non-Commercial, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que sem fins comerciais e que o trabalho original seja corretamente citado. Fístula arteriovenosa hepática em cão: relato de casoHepatic arteriovenus fistula in dog -case report AbstractHepatic arteriovenous fistulas are vascular communications between a hepatic artery and a portal vein causing the blood to bypass the hepatic sinusoid network and return by retrograde flow to the portal system. This rare occurrence can be congenital or acquired, and can lead to anorexia, weight loss, diarrhea, neurological and ascites, and has portosystemic deviation as the main diagnosis. The clinical treatment is palliative, requiring surgery to definitively resolve the disease. The present report reports a case of arteriovenous fistula in dogs, from the beginning of the clinical signs, the diagnosis and exclusively clinical treatment carried out, having a survival approximately 19 months.Keywords: Hepatic vascularization, canine, treatment. IntroduçãoAs fístulas arteriovenosas intra-hepática (FAVH), são comunicações vasculares entre a artéria hepática e a veia porta fazendo com que o sangue se desvie da rede sinusóide hepática e retorne por fluxo retrógrado para o sistema portal. Essas afecções podem afetar um ou mais lobos hepáticos, sendo o lobo medial direito o mais acometido (Johnson, 2004).De rara ocorrência, as FAVH podem ter causas congênitas, traumáticas ou neoplásicas (Johnson, 2004). Em cães e gatos a maioria das FAVH são congênitas, provavelmente refletindo a falha na diferenciação das estruturas venosas e arteriais embrionárias (Hopper et al., 1983).As principais causas de FAVH adquirida incluem trauma abdominal, cirurgias hepáticas, neoplasias hepáticas, ruptura de aneurisma, obstrução da veia hepática e cirrose. As FAVH são diagnosticadas com mais frequência em cães com idade inferior a um ano e meio de idade, sendo a média de seis meses de idade (Johnson, 2004).As manifestações clínicas de animais com FAVH são: anorexia, perda de peso, diarreia, êmese, dor abdominal, falha de crescimento, poliúria, polidipsia, febre, alteração neurológica e ascite. As alterações neurológicas estão relacionadas com a encefalopatia hepática (Chanoit et al., 2007).

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“…Congenital extrahepatic portosystemic shunts (EHPSS) are anomalous vessels that connect portal and systemic venous circulation, allowing blood to bypass the liver . Clinical signs include gastrointestinal dysfunction, hepatic encephalopathy, coagulopathies, and lower urinary tract abnormalities .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of different methods of securing cellophane bands for portosystemic shunt attenuation

et al. 2018

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Objective: To compare mechanisms of and pressures at failure of 4 methods of securing 2 types of cellophane bands around a vein. Study design: Ex vivo mechanical evaluation. Methods: Cellophane bands composed of 3 or 4 layers were applied around a cadaveric external jugular vein (EJV) to create 25% or 50% attenuation. These bands were secured with a medium or medium-large polymer locking ligation clip (PLLC), or a medium or medium-large titanium ligation clip (TLC). Sterile saline 0.9% was instilled into the lumen of the EJV until a pressure of 100 mm Hg was reached. Failure mechanism and luminal pressure at failure were compared between groups. Results: Medium clips failed less often than medium-large clips (P < .001) and consistently sustained 100 mm Hg without failing. Three-layer cellophane bands were 4.1 times more likely to fail than 4-layer bands (P = .003, CI 1.6-10.2) and failed at lower pressures (28.32 ± 3.59 mm Hg and 44.81 ± 6.51 mm Hg, respectively, P = .027). Failure rates of the cellophane band constructs did not differ whether secured with PLLC or with TLC (P = .635) or with 25% vs 50% attenuation (P = .780). Conclusion: A single medium clip withstood physiological forces and secured a cellophane band at up to 50% attenuation. A 3-layer cellophane band was more likely to fail compared with a 4-layer cellophane band. Clinical significance: These ex vivo results provide evidence to support the application of a 4-layer cellophane band secured with a single medium PLLC or TLC for portosystemic shunt attenuation. A single medium PLLC should be used to eliminate computed tomography artifacts during postoperative evaluation of shunt closure.

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Current Concepts in Congenital Portosystemic Shunts

Cited by 24 publications

References 43 publications

Implications of shunt morphology for the surgical management of extrahepatic portosystemic shunts

Implications of shunt morphology for the surgical management of extrahepatic portosystemic shunts

Fístula Arteriovenosa Hepática Em Cão: Relato De Caso

Evaluation of different methods of securing cellophane bands for portosystemic shunt attenuation

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