Treatment of intrahepatic congenital portosystemic shunts in dogs: a systematic review.

M S Tivers,D J Brockman,V J Lipscomb

doi:10.1111/jsap.12712

Abstract

The aim of this study was to establish the evidence base for the treatment of intrahepatic congenital portosystemic shunts in dogs through a systematic review of the pertinent literature. Studies were filtered for evidence to answer the question "Which of the treatment options for intrahepatic CPSS in dogs offers the best short- and long-term outcome?" Studies were assigned a level of evidence based on a system published by the Oxford Centre for Evidence-Based Medicine. Thirty-two studies were included in the review. Twenty-six provided level 4 evidence and six provided level 5 evidence. There were no level 1, 2 or 3 studies. One study compared surgical treatment with medical management and one study compared suture ligation with ameroid constrictor placement. The remaining studies were case series describing the outcome for one treatment method alone. Methods and timings of assessments of short- and long-term outcomes were highly varied, making direct comparisons challenging. The evidence regarding the treatment of intrahepatic congenital portosystemic shunts in dogs is weak, with only two studies directly comparing treatments. There is a lack of evidence regarding short- and long-term outcomes on which to base clinical decisions.

Highlights

Road traffic accident (RTA) known as motor vehicle accident (MVA) is one of the most common causes of blunt trauma in dogs 1
Sample size calculations estimated that a cross-sectional study would require 16,608 males and 16,608 females to identify an effect with an odds ratio of 1.5 or greater, a confidence interval (CI) of 95%, and power 80% when the ratio of exposed-to-unexposed was 1:1 and 0.5% of the unexposed animals were estimated to have an RTA outcome 15
This study, the first major exploration of RTA in dogs attending primary-care veterinary practices in England, reports a prevalence of 0.41%. It confirms that RTA is one of the major disorders in dogs, having a similar prevalence to other common disorders such as epilepsy,[14] cranial cruciate disease (0.56%),[20] chronic kidney disease (0.37%), and diabetes mellitus (0.34%)[21]

Summary

Introduction

Road traffic accident (RTA) known as motor vehicle accident (MVA) is one of the most common causes of blunt trauma in dogs 1. Previous evidence has identified RTA as the fourth most common cause of death in dogs under three years of age, with 12.7% of deaths in young dogs occurring from RTA 2. RTA has been reported to be the cause of 55% of head trauma cases in dogs 3. The prevalence of RTA in dogs in the UK is unknown and risk factors for involvement in RTAs, such as breed and age, have not been described. Epidemiologic information has been shown to be important for prevention, diagnosis, and management in many other disease processes, any potential in relation to RTA is unclear

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