Health-related quality of life following surgical attenuation of congenital portosystemic shunts versus healthy controls.

P Bristow,M Tivers,K Newson,K Homan,V Lipscomb,A Kummeling,V Ortiz,R Packer,H Gerrits

doi:10.1111/jsap.12927

Abstract

To design a health-related quality of life questionnaire for dogs with congenital portosystemic shunts, use it in a cohort of dogs treated with suture attenuation and compare results with those obtained from a healthy control cohort. Data were collected from the hospital records of dogs treated with suture ligation of an intrahepatic or extrahepatic congenital portosystemic shunt at two referral centres. Owners were asked to complete a questionnaire assessing their dog's health-related quality of life preoperatively (retrospectively) and at the time of follow-up. Owners of control dogs also completed the questionnaire. One hundred and twenty-eight dogs with congenital portosystemic shunts and 131 control dogs were recruited. Median follow-up time was 64 months (range 19.7 to 157.2). The median long-term health-related quality of life score was excellent for both intrahepatic and extrahpatic shunt cases and similar to that of control dogs. The long-term portosystemic shunt clinical sign scores for both intrahepatic and extrahepatic congenital portosystemic shunt dogs were significantly worse than the those of the control group. Suture attenuation of congenitial portosystemic shunts is associated with an excellent health-related quality of life score at long-term follow-up.

Highlights

A congenital portosystemic shunt (CPSS) is an abnormal vascular communication that diverts blood away from the portal circulation into the systemic circulation
Clinical significance: Suture attenuation of congenitial portosystemic shunts is associated with an excellent health-realted quality of life score at long-term follow-up
Summaries of the results of the questionnaire for EHCPSS dogs, IHCPSS dogs and control dogs are presented in tables 5-7 and Appendix 4

Summary

Introduction

A congenital portosystemic shunt (CPSS) is an abnormal vascular communication that diverts blood away from the portal circulation into the systemic circulation. The CPSS may be intrahepatic or extrahepatic and results in liver hypoplasia and functional hepatic insufficiency. Surgery to attenuate the shunting vessel, re-directing hepatic portal blood flow to the liver, is the preferred treatment (Greenhalgh et al 2014). There are several surgical techniques used to achieve partial or complete attenuation of both intrahepatic and extrahepatic CPSS in dogs including suture attenuation, cellophane banding, ameroid constrictor and coil embolisation The current available reports have examined various techniques and different clinical variables to assess the outcome and success; including liver function tests (ammonia, bile acids), imaging to detect persistent shunting (scintigraphy and ultrasound) and owner assessment

Objectives

Methods

Results