Portosystemic Shunts Flashcards
Kraun, JAVMA, 2014:
EHPSS
- Neuro signs were more common in dogs with shunts inserting where in relation to the liver?
- Shunts originating from which vessel were more likely to be associated with urinary signs?
- What % of dogs had urinary calculi or mineralization?
- Albumin concentrations were lower in dogs with which type of shunts?
- What breed of dog was 36 times as likely to develop an EHPSS than any other breed?
Kraun, JAVMA, 2014:
- Neuro signs were more common in dogs with shunts inserting caudal to the liver
- Shunts originating from the right gastric vein were more likely to be associated with urinary signs than shunts originating from the splenic vein
- 60% had urinary calculi or mineralization
- Albumin concentrations were lower in dogs with portocaval shunts than those with portoazygos shunts
- Yorkies were 36 times as likely to develop an EHPSS than any other breed
Caporali, JAVMA, 2015:
EHPSS
- What % of dogs had crystalluria, and what were the most common type(s) of crystals?
- 94% of the uroliths analyzed were composed of what?
- Risk factors for urolithiasis?
Caporali, JAVMA, 2015:
- 37% had crystalluria, mainly ammonium urate and struvite crystals
- 94% of the uroliths analyzed were composed of ammonium urate
- Risk factors for urolithiasis: male dogs, older dogs, dogs that received previous medical treatment
Tamura, VRU, 2019:
Contrast-enhanced ultrasonography in EHPSS:
What finding could be used as an additional diagnostic test to distinguish EHPSS dogs from healthy dogs?
Tamura, VRU, 2019:
Rapid hepatic artery and hepatic parenchyma enhancements may reflect a compensatory increase in hepatic artery blood flow (arterialization) caused by a decrease in portal vein blood flow, and may be used as an additional diagnostic test to distinguish EHPSS dogs from healthy dogs
Joffe, Vet Surg, 2019:
Methods of securing cellophane bands for EHPSS
- Cellophane bands with how many layers were more likely to fail and failed at lower pressures?
- Difference in failure rates between bands applied to create 25% vs 50% attenuation?
- What sized clips failed less often?
- Difference in failure rates between polymer locking ligation clips vs titanium ligation clips?
Joffe, Vet Surg, 2019:
- 3-layer cellophane bands were 4 times more likely to fail than 4-layer cellophane bands and failed at lower pressures
- No difference in failure rates between bands applied to create 25% vs 50% attenuation
- Medium clips failed less often than medium-large clips
- Failure rates did not differ between polymer locking ligation clips and titanium ligation clips
Weisse, JAVMA, 2018:
IHPSS
- Major intra-op complication rate?
- Minor intra-op complication rate?
- Early post-op complication rate?
- What % of dogs had post-op GI hemorrhage?
- Outcomes?
- MST?
- Dogs with shunts in which division of the liver had better outcomes?
Weisse, JAVMA, 2018:
- Major intra-op complication rate: 3%
- Minor intra-op complication rate: 12%
- Early post-op complication rate: 16%
- 21% had post-op GI hemorrhage
- 66% excellent outcomes, 15% fair outcomes, 19% poor outcomes
- MST: >6 years
- Dogs with central divisional shunts had better outcomes (80% excellent outcome)
Culp, Vet Surg, 2018:
Percutaneous transvenous coil embolization (PTCE) for IHPSS
- Intra-op complication rate?
- Short-term post-op complication rate?
- Long-term post-op complication rate?
- What % of dogs had a decrease in shunt fraction post-op?
- What % of dogs had resolution of clinical signs at 3 months post-op?
Culp, Vet Surg, 2018:
- Intra-op complication rate: 8%
- Short-term post-op complication rate: 8%
- Long-term post-op complication rate: 8%
- 70% of dogs had a decrease in shunt fraction post-op, but none of the dogs had shunt fractions within the normal range
- 92% of dogs had resolution of clinical signs at 3 months post-op
Case, Vet Surg, 2018:
Cellophane banding vs percutaneous transvenous coil embolization (PTCE) for IHPSS
- Any differences in resolution of clinical signs and improvements in hepatic biochemical markers post-op for cellophane banding vs PTCE?
- Which technique had fewer post-op complications?
Case, Vet Surg, 2018:
- No difference in resolution of clinical signs and improvements in hepatic biochemical markers post-op for cellophane banding vs PTCE
- PTCE had fewer post-op complications
Smith, Vet Surg, 2013:
Cellophane bands
- Saline immersion reduced the strength of cellophane bands by how much?
- Effects of various methods of sterilization on the strength of cellophane bands?
Smith, Vet Surg, 2013:
- Saline immersion reduced the strength of cellophane bands by 48%
- All sterilization methods except autoclaving significantly weakened wet cellophane
Hunt, Vet Surg, 2014:
Ameroid ring constrictor (ARC) for EHPSS
What % of dogs had residual flow through the shunt?
Hunt, Vet Surg, 2014:
18% had residual flow through the shunt
Nelson and Nelson, Vet Surg, 2016:
Cellophane banding for EHPSS:
- Of the dogs that underwent complete attenuation, what were their shunt fractions post-op?
- Cellophane banding resulted in improvement in biochemical and imaging parameters despite partial attenuation or cellophane band placement in a suboptimal location - true or false?
Nelson and Nelson, Vet Surg, 2016:
- Of the dogs that underwent complete attenuation, their post-op shunt fractions were <10%
- True
Traverson, Vet Surg, 2018:
Ameroid ring constrictor (ARC) vs cellophane banding for EHPSS
- What % of shunts were correctly localized by ultrasound?
- What % of dogs had concurrent urinary calculi?
- Post-op complication rate for ARC vs cellophane banding?
- Most severe complication?
- Post-op mortality rate for ARC vs cellophane banding?
- Parameters of hepatic function returned to normal in what % of dogs following ARC vs cellophane banding?
- Complete shunt occlusion was achieved at a median of 5 months post-op in what % of dogs following ARC vs cellophane banding?
- What was a risk factor for post-op complications?
Traverson, Vet Surg, 2018:
- Shunt location was consistent with ultrasonographic localization in 82% of the dogs
- 41% had concurrent urinary calculi
- Post-op complication rate: 26% for ARC vs 23% for cellophane banding
- Coagulopathy was the most severe complication
- Post-op mortality rate: 4% for ARC vs 0% for cellophane banding
- Parameters of hepatic function returned to normal in 18% of ARC dogs vs 12% of cellophane banding dogs
- Complete shunt occlusion was achieved at a median of 5 months post-op in 100% of ARC dogs vs 53% of cellophane banding dogs
- Lower body weight was a risk factor for post-op complications - for every 1kg increase in body weight, the odds of developing post-op complications decreased by 30%
Wallace, Vet Surg, 2018:
Self-retaining polyacrylic acid-silicone device for attenuation of an EHPSS
- What % of shunts had complete attenuation by 4 weeks post-op and what % had complete attenuation by 8 weeks post-op?
- Bile acids concentration normalized in what % of dogs?
Wallace, Vet Surg, 2018:
- 33% had complete attenuation by 4 weeks post-op and 33% had complete attenuation by 8 weeks post-op; the remaining 34% had continued mild residual flow at 8 weeks post-op
- Bile acids concentrations normalized in 83% of the dogs
Strickland, Vet Surg, 2018:
Post-attenuation neurological signs (PANS)
- What % of dogs developed PANS?
- Risk factors for developing PANS?
- What factor(s) were not associated with the development of PANS?
- Effect(s) of prophylactic administration of levetiracetam?
Strickland, Vet Surg, 2018:
- 11% developed PANS
- Risk factors for PANS: pre-op hepatic encephalopathy (increased odds of PANS by 2.7-fold), increasing age (each year increase in age increased the odds of PANS 1.5-fold)
- Pre-op ammonia levels and shunt location (extrahepatic vs intrahepatic) were not associated with development of PANS
- Prophylactic administration of levetiracetam did not reduce the development of PANS or seizures
Mullins, Vet Surg, 2019:
Post-attenuation neurological signs (PANS)
- Overall incidence of PANS?
- Effect of prophylactic treatment with levetiracetam on incidence of PANS?
Mullins, Vet Surg, 2019:
- Overall incidence of PANS: 8%
- Prophylactic treatment with levetiracetam was not associated with a reduced incidence of PANS
Greenhalgh, JAVMA, 2014:
- Overall mortality rate?
- Did the surgical treatment group or the medical treatment group have a higher survival rate?
- Did the surgical treatment group or the medical treatment group have fewer or less frequent clinical signs in the long-term follow-up period?
Greenhalgh, JAVMA, 2014:
- Overall mortality rate: 36%
- The surgical treatment group had a higher survival rate
- The surgical treatment group had fewer or less frequent clinical signs in the long-term follow-up period