Types Of Portosystemic Shunts Research Articles

Computed tomographic measures of renomegaly vary among dogs with different types of congenital portosystemic shunts.

Renomegaly has been reported in dogs with congenital portosystemic shunts (PSS). However, no study has objectively evaluated the degree of renomegaly in dogs with different types of PSS. The purpose of this retrospective, analytical, cross-sectional study was to determine kidney size (renal length-to-L2 vertebral body ratio; RL/L2 ratio) using CT in dogs with different types of PSS and correlate with clinical information. A medical record search for dogs with a PSS diagnosed using CT between 2016 and 2020 was conducted. Breed, age, sex, body weight, and biochemistry results were recorded. Kidney and L2 vertebral body lengths were measured using multiplanar reformatted CT images, and the RL/L2 ratio was calculated. Dogs were categorized into four groups based on PSS morphology for comparisons: intrahepatic (IH; n=19), extrahepatic portocaval (EHPC; n=20), extrahepatic portoazygos (EHPA; n=7), or extrahepatic portophrenic (EHPP, n=7). The RL/L2 ratio (mean±SD) was largest in IH (3.55±0.38) and EHPC (3.55±0.38), followed by EHPP (3.10±0.23), and EHPA (2.78±0.18). RL/L2 ratio was significantly larger in EHPC and IH (vs. EHPA and EHPP [P<.01]). Significant correlations between kidney size and creatinine, alkaline phosphatase, albumin, total protein, and ammonia were present. Renomegaly was observed in 86.8% of dogs with PSS overall, but it was uncommon in dogs with EHPA and less common in dogs with EHPP, as these two groups showed clinical signs later in life, made evident by older age at presentation. The authors suggest that the severity of hepatic dysfunction and the shunted blood volume may influence the development of renomegaly in dogs with PSS.

Assessment of plasma protein C activity in dogs with portosystemic shunt

Portosystemic shunt (PSS) is a vascular disease that can be treated by various surgical techniques. Current veterinary studies are evaluating new prognostic markers in dogs with PSS. This study aims at evaluating the prognostic value of plasma protein C activity in dogs (n = 34) with PSS treated surgically using an ameroid constrictor. Plasma protein C activity was measured in the following time periods: preoperatively (T1), 2 days after surgery (T2), 8 weeks after surgery (T3) and &gt; 6 months after surgery (T4). There was a significant increase in plasma protein C activity between T1/T2 and T3/T4 (P &lt; 0.001). There was no significant relationship between the plasma protein C activity and sex (P = 0.676), age (P = 0.172), breed (P = 0.573), type of clinical signs (neurological P = 0.993; gastrointestinal P = 0.924; urological P = 0.385) and type of portosystemic shunt (P = 0.516), except for dogs with a caval type of extrahepatic PSS termination that had significant lower plasma protein C activity values compared to dogs with a diaphragmatic type of extrahepatic PSS (P = 0.031). No significant relationship was found between plasma protein C activity and the probability of the dog’s death (P = 0.334) or the dog’s clinical outcome (P = 0.960). Although not a prognostic factor, protein C activity is a laboratory marker that is useful for the diagnosis of PSS in dogs and can also be helpful in the postoperative monitoring.

Клинико-гематологическая и томографическая характеристика внепеченочных портосистемных шунтов у собак

The liver performs various biological functions in the body, including removing many toxins from the bloodstream and producing proteins that promote blood clotting. Liver diseases are a common problem in veterinary medicine in small pets. There are several types of vascular abnormalities of the liver, manifested in dogs and cats. The article considers the classification of one of the types of anomalies of the portal venous system – portosystemic shunts (PSS). The statistical data of the most common types of PSS are presented on the basis of their own clinical cases from veterinary practice. Studies were conducted on 30 dogs. It was found that the most common extrahepatic vascular anomalies are: splenocaval PSS – 33 % of cases; splenoazigonal – 30 %; splenophrenal – 17 %; right gastrocaval shunt – 10 %; right gastrocaval shunt with caudal loop – 7 %; right gastroasigonal shunt with caudal loop – 3 %.

Clinical and laboratory outcome after surgical treatment of single congenital extrahepatic portosystemic shunt using ameroid constrictor in 25 dogs

The objective of the study was to evaluate the clinical and laboratory outcome after the surgical treatment of a single congenital extrahepatic portosystemic shunt using an ameroid constrictor. Patient medical records were reviewed in retrospect. Data on the signalment, clinical signs, preoperative bile acid stimulation test and ammonia concentration were recorded. The surgical treatment success rate was evaluated by mortality in the perioperative and short-term postoperative period and by the long-term clinical outcome. Bile acid stimulation test and ammonia concentration were also analysed 2–3 days, 4–6 weeks, and 6–8 weeks postoperatively. No patient died in the selected periods. The long-term clinical outcome was excellent in 15 out of 20 patients, good in 3 out of 20 patients and poor in 2 out of 20 patients. Preprandial bile acid concentration was elevated in 96.00%, postprandial bile acid concentration in 100.00% and ammonia concentration in 80.95% of patients preoperatively. A significant decrease was found in postprandial bile acid and ammonia 2–3 days postoperatively and in preprandial bile acid 4–6 weeks postoperatively. A significant decrease in liver function parameters in days post operation indicates a rapid restoration of hepatic function. The surgical treatment of a single extrahepatic portosystemic shunt using an ameroid constrictor is a successful method of treatment for this type of portosystemic shunt, with as much as 75.00% of the patients having an excellent long-term clinical outcome.

Computed tomographic-derived measurements of shunt fraction and hepatic perfusion in dogs with a single extrahepatic portosystemic shunt in a clinical setting.

To evaluate the clinical feasibility and usefulness of measuring shunt fraction (SF) and hepatic perfusion with CT in dogs with a single extrahepatic portosystemic shunt (EPSS). 36 client-owned dogs with EPSS. Dogs with EPSS referred for treatment between February 2016 and May 2017 were eligible for the clinical trial. Shunt type, SF, and hepatic perfusion were determined in each dog with a 320-row multidetector CT scanner, and surgical treatment was performed by a single veterinary surgeon. Differences in results between dogs grouped according to age (< 3 years vs ≥ 3 years), shunt type, and subgroups (eg, clinical signs and surgical procedure) were analyzed, and correlations between the SF and hepatic perfusion variables were evaluated. The median SF was higher in dogs < 3 years old (74.6%; n = 18) versus dogs ≥ 3 years old (35.1%; 18). Correlations were identified between SF and hepatic perfusion variables, and differences in results for SF and hepatic perfusion variables were detected between dogs grouped according to shunt type. Results indicated that CT-derived measurements of SF and hepatic perfusion variables in dogs with EPSS were feasible and could be useful (eg, estimating EPSS condition status and planning treatment) in clinical settings. In addition, our findings suggested that perfusion CT could be useful for distinguishing hemodynamic characteristics among different types of portosystemic shunts in dogs.

Portosystemic Shunt Surgery in Patients with Idiopathic Noncirrhotic Portal Hypertension.

BACKGROUND Idiopathic noncirrhotic portal hypertension (INCPH) is a rare disease characterized by increased portal venous pressure in the absence of cirrhosis and other causes of liver diseases. The aim of the present study was to present our results in using portosystemic shunt surgery in patients with INCPH. MATERIAL AND METHODS Patients who had been referred to our Liver Transplantation Institute for liver transplantation and who had undergone surgery from January 2010 to December 2015 were retrospectively analyzed. Patients with INCPH who had undergone portosystemic shunt procedure were included in the study. Age, sex, symptoms and findings, type of portosystemic shunt, and postoperative complications were assessed. RESULTS A total of 1307 patients underwent liver transplantation from January 2010 to December 2015. Eleven patients with INCPH who did not require liver transplantation were successfully operated on with a portosystemic shunt procedure. The mean follow-up was 30.1±19 months (range 7-69 months). There was no mortality in the perioperative period or during the follow-up. Two patients underwent surgery again due to intra-abdominal hemorrhage; one had bleeding from the surgical site except the portacaval anastomosis and the other had bleeding from the h-graft anastomosis. No patient developed encephalopathy and no patient presented with esophageal variceal bleeding after portosystemic shunt surgery. Shunt thrombosis occurred in 1 patient (9.9%). Only 1 patient developed ascites, which was controlled medically. CONCLUSIONS Portosystemic shunt surgery is a safe and effective procedure for the treatment of patients with INCPH.

Portosystemic Shunts for "Too Small-for-Size Syndrome" After Liver Transplantation: A Systematic Review.

Portosystemic shunts (PSSs) modulate the portal hyperperfusion against small-for-size syndrome (SFSS) after split or living donor liver transplantation. To find out the results and the limitations of PSSs against SFSS. We searched PubMed and Cochrane databanks for systematic review and analyzed the indications, types, morbidities, and survivals of the PSSs at split or living donor liver transplantations. Total 66 patients were assessed in 16 studies. Main indications for PSS were graft recipient weight ratio (GRWRs) <0.8% and/or portal vein pressure >20mmHg. Five different types of PSSs were described but hemi-portocaval shunts were the most common one. The incidence of SFSS was 12%. Overall 90-day, 1-, and 3-year graft survivals were 80, 70, and 47%, respectively. GRWR <0.65% was found as the only significant parameter on graft survival. The 90-day, 1- and 3-year graft survivals for GRWR <0.65 and ≥0.65% patients were 62.5, 42.8, and 30.0 and 95, 94, and 67%, respectively (p=0.03, p=0.01, and p=0.18). PSSs can modulate the small graft size (GRWR<0.8%) and/or portal hypertension (>20mmHg) after split or living donor liver transplantations sufficiently. However, its protective effect is not unlimited. If the GRWR is below 0.65%, survival decreases significantly despite PSSs.

Derivación ilíaca-mesentérico-cava en pacientes menores de dos años de edad: Informe de casos y revisión de la literatura

Introduction: In the treatment of portal hypertension in pediatric patients, some type of porto-systemic shunt is indicated, which is an unusual surgical procedure in patients under two years of age, due to the low incidence of this disease at this age and the increase in the number of complications. Objective: We present our experience and results with this procedure in patients under two years of age seen in the Hepatobiliopancreatic general surgery service at Instituto Nacional de PediatriaDiscussion: The causes of portal hypertension in children are varied. Among the extrahepatic causes, the most common is cavernomatous portal degeneration. Children with portal hypertension under two years have severe symptoms such as recurrent gastrointestinal bleeding or anemia; others have hypersplenism data. In many cases medical management is useless and a surgical procedure require such as a portosystemic shunt in order to decrease the size of varicose esophageal veins and prevent bleeding that threatens the patient’s life. Conclusion: The iliac-mesenteric-caval shunt in patients under two years is a feasible alternative that improves the clinical status of the patient, reducing the risk of bleeding. However long-term studies are needed to determine the outcome of these patients. Keywords: Iliac-mesenteric-caval shunt, portal hypertension.

Pharmacological versus endoscopic therapy in the prevention of variceal hemorrhage: And the winner is…

Pharmacological versus endoscopic therapy in the prevention of variceal hemorrhage: And the winner is…

Which is the best surgery for Budd-Chiari syndrome: Venous decompression or liver transplantation? A single-center experience with 50 patients

The optimal treatment of Budd-Chiari syndrome (BCS) remains an open question. It is still a matter of controversial discussion whether venous decompression or liver transplantation is superior. To elucidate the role and prognosis of both surgical options in our own experience, a consecutive series of 50 patients treated between 1981 and 1993 was retrospectively analyzed. Twelve patients had different types of portosystemic shunts or local decompressive procedures, and transplantation was performed in 43 cases, including five with previous conventional surgery. The overall mortality of 18 of 50 was concentrated within the early postoperative period, with no patient lost after 1 year. In the venous decompression group, the success rate was only 29%, and treatment failure was closely related to the finding of cirrhosis or technical problems like vascular thrombosis. After transplantation, early complications were rejection, primary nonfunction, or graft necrosis, and contributed significantly to the risk of sepsis. Thirty of 43 liver recipients are currently alive, including four rescued after failed decompressive surgery, with 1- and 10-year survival of 69%, and excellent recurrence-free rehabilitation. These results clearly indicate that patient selection plays a dominant prognostic role in the treatment of BCS. Venous decompression and liver transplantation should both be integrated in a common therapeutic concept, and the individual decision for the preferred approach must be based on the leading clinical symptom: portal hypertension or liver failure, together with the assessment of reversibility of hepatic damage, and the potential of cure of the underlying disease.

Which is the best surgery for budd-chiari syndrome: Venous decompression or liver transplantation? a single-center experience with 50 patients

The optimal treatment of Budd-Chiari syndrome (BCS) remains an open question. It is still a matter of controversial discussion whether venous decompression or liver transplantation is superior. To elucidate the role and prognosis of both surgical options in our own experience, a consecutive series of 50 patients treated between 1981 and 1993 was retrospectively analyzed. Twelve patients had different types of portosystemic shunts or local decompressive procedures, and transplantation was performed in 43 cases, including five with previous conventional surgery. The overall mortality of 18 of 50 was conventional surgery. The overall mortality of 18 of 50 was concentrated within the early postoperative period, with no patient lost after 1 year. In the venous decompression group, the success rate was only 29%, and treatment failure was closely related to the finding of cirrhosis or technical problems like vascular thrombosis. After transplantation, early complications were rejection, primary nonfunction, or graft necrosis, and contributed significantly to the risk of sepsis. Thirty of 43 liver recipients are currently alive, including four rescued after failed decompressive surgery, with 1- and 10-year survival of 69%, and excellent recurrence-free rehabilitation. These results clearly indicate that patient selection plays a dominant prognostic role in the treatment of BCS. Venous decompression and liver transplantation should both be integrated in a common therapeutic concept, and the individual decision for the preferred approach must be based on the leading clinical symptom: portal hypertension or liver failure, together with the assessment of reversibility of hepatic damage, and the potential of cure of the underlying disease.