Evaluation of a portocaval venograft and ameroid ring for the occlusion of intrahepatic portocaval shunts in dogs.

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.

Percutaneous ultrasound-guided trans-splenic catheterization of the portal vein in the dog.

The purpose of this investigation was to develop a safe and reliable technique for percutaneous catheterization of the portal vein via a major splenic vein using ultrasound guidance. Three separate catheter systems were evaluated on five anesthetized dogs. At least five attempts at catheterization of the splenic vein and subsequently the portal vein were attempted on each animal. Following the procedure the dogs were necropsied to assess for intrasplenic and intraabdominal hemorrhage. A technique using an introducer system and a large catheter was not successful on seven attempts. A technique using an over the needle catheter was successful in gaining access to the splenic vein on two out of five attempts; however the catheter could not be advanced into the portal vein. A technique utilizing 19 or 17 gauge needles with 22 or 19 catheter through-the-needle-catheters was successful in catheterization of the splenic vein and advancement to the portal vein on twelve of fifteen attempts. The smaller gauge needle and catheter system provided for easier access to the splenic vein and subsequent catheter manipulation facilitating access to the portal circulation.

Persistent frenulum of the epiglottis in four foals.

OBJECTIVE: To report the clinical signs and management of 4 foals with persistent frenulum of the epiglottis. STUDY DESIGN: Case report. ANIMALS: Four newborn foals. METHODS: Foals were admitted with a complaint of oronasal reflux after nursing. Variable systemic signs of aspiration pneumonia were evident. Nasal endoscopy confirmed persistent dorsal displacement of the soft palate. Persistent frenulum of the epiglottis, confirmed by oral endoscopic examination, was transected. RESULTS: After surgery, all foals had the epiglottis positioned normally, dorsal to the soft palate. Clinical signs of oronasal reflux resolved by the second nursing attempt in 3 foals, whereas this was difficult to assess in one foal that was nursed intermittently because of the mares behavior. This foal died 2 days later. The other 3 foals have had normal epiglottic function for 2-4 years. CONCLUSIONS: Persistent frenulum of the epiglottis should be considered in foals with oronasal reflux from birth. With appropriate medical and surgical management the prognosis for resolution should be good.