H W Boothe1, L M Howe, J F Edwards, M R Slater. 1. Department of Veterinary Small Animal Medicine, College of Veterinary Medicine, Texas A&M University, College Station 77843, USA.
Abstract
OBJECTIVE: To describe the long-term outcome in dogs with naturally developing multiple extrahepatic portosystemic shunts (PSS). DESIGN: Retrospective case series. ANIMALS: 30 dogs with multiple PSS. PROCEDURE: Medical records of dogs with multiple PSS were reviewed. Follow-up data were obtained by 1 or more of the following methods: recheck at the veterinary teaching hospital (n = 6) or telephone contact with the referring veterinarian (n = 18) or owner (n = 10). The chi 2 or Mann-Whitney rank sum test was used to determine the association of clinical factors with long-term outcome. Survival curves were generated by the Kaplan-Meier product limit method. RESULTS: Median age at diagnosis was 1 year. Findings on exploratory surgery in 25 dogs included ascites; numerous tortuous vessels connecting the portal vein with systemic veins; a small, misshapen liver; and an enlarged portal vein. The most common lesions on histologic evaluation of hepatic tissue specimens were hepatocellular atrophy, portal vascular duplication, cirrhosis, inflammation, and bile duct proliferation. Twelve dogs were treated surgically with vena caval banding, whereas 13 dogs were treated conservatively with dietary restriction of protein and administration of antibiotics, diuretics, and other drugs. Long-term survival and quality of life were similar in dogs from both treatment groups. Median follow-up interval in dogs that survived hospitalization was 24 months (range, 1 to 54 months). CLINICAL IMPLICATIONS: On the basis of these findings, vena caval banding in dogs with multiple PSS is not superior to medical and nutritional treatment.
OBJECTIVE: To describe the long-term outcome in dogs with naturally developing multiple extrahepatic portosystemic shunts (PSS). DESIGN: Retrospective case series. ANIMALS: 30 dogs with multiple PSS. PROCEDURE: Medical records of dogs with multiple PSS were reviewed. Follow-up data were obtained by 1 or more of the following methods: recheck at the veterinary teaching hospital (n = 6) or telephone contact with the referring veterinarian (n = 18) or owner (n = 10). The chi 2 or Mann-Whitney rank sum test was used to determine the association of clinical factors with long-term outcome. Survival curves were generated by the Kaplan-Meier product limit method. RESULTS: Median age at diagnosis was 1 year. Findings on exploratory surgery in 25 dogs included ascites; numerous tortuous vessels connecting the portal vein with systemic veins; a small, misshapen liver; and an enlarged portal vein. The most common lesions on histologic evaluation of hepatic tissue specimens were hepatocellular atrophy, portal vascular duplication, cirrhosis, inflammation, and bile duct proliferation. Twelve dogs were treated surgically with vena caval banding, whereas 13 dogs were treated conservatively with dietary restriction of protein and administration of antibiotics, diuretics, and other drugs. Long-term survival and quality of life were similar in dogs from both treatment groups. Median follow-up interval in dogs that survived hospitalization was 24 months (range, 1 to 54 months). CLINICAL IMPLICATIONS: On the basis of these findings, vena caval banding in dogs with multiple PSS is not superior to medical and nutritional treatment.