Intrahepatic venous collaterals in dogs with congenital intrahepatic portosystemic shunts are associated with focal shunt or hepatic vein narrowing

Abstract

Dogs with congenital intrahepatic portosystemic shunts (IHPSS) occasionally have multiple smaller intrahepatic, tortuous blood vessels surrounding the primary shunt. This study was a retrospective, observational design that was also descriptive and anatomic in nature. Objectives were to characterize vascular morphology in IHPSS dogs presenting with intrahepatic venous collaterals (IVCs) relative to IHPSS dogs without IVCs, and to propose reasons for IVC development. The authors hypothesized that (a) IVCs develop secondary to flow resistance around a focal area of a shunt or draining hepatic vein narrowing and (b) the presence of IVC is associated with portal vessel development before intervention. Anonymized CT angiograms (CTA) and fluoroscopic portovenograms (FPV) of dogs with IHPSS were evaluated for the presence of IVCs, focal narrowing within the IHPSS, and intrahepatic portal vessels>5mm long. Eleven of 47 (23%) dogs had IVCs identified. IVCs were significantly associated with focal narrowing in the shunt or draining hepatic vein on CTA (P=0.039) and FPV (P=0.021). IVCs were not associated with the presence of intrahepatic portal branches>5mm long on portovenography (P=0.42) or CTA (P=0.49). Focal narrowing in the shunt (circumferential soft tissue narrowing>20% of the shunt diameter) was significantly associated with intrahepatic portal branches>5mm long on both modalities (P<0.001). IVCs are associated with focal narrowing of the shunt or draining hepatic vein in dogs with IHPSS. IVC should be distinguished from other conditions when evaluating a CTA for canine IHPSS.