Association of mesenteric portovenographic findings with outcome in cats receiving surgical treatment for single congenital portosystemic shunts

Lipscomb, V J and Lee, K C L and Lamb, C R and Brockman, D J (2009) Association of mesenteric portovenographic findings with outcome in cats receiving surgical treatment for single congenital portosystemic shunts. JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION, 234 (2). pp. 221-228.

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Abstract

Objective-To determine whether hepatic portal vascularity assessed via intraoperative mesenteric portovenography (IMP) is related to outcome in cats undergoing surgical attenuation of a congenital portosystemic shunt (CPSS). Design-Retrospective case series. Animals-25 cats, each with 1 CPSS, in which IMP was performed before and after temporary complete occlusion of the shunting vessel to provide complete (n = 9) or partial (16) shunt attenuation. Procedures-Medical records were reviewed for signalment, clinical history, postoperative complications, clinical outcome, and results of bile acids stimulation testing. Portovenograms obtained before and after shunt occlusion were graded to determine whether degree of intrahepatic portal branching was correlated with degree of shunt attenuation, clinical or biochemical factors, postoperative complications, or outcome. In 12 of the 16 cats that had partial CPSS attenuation, procedures were later repeated to achieve complete (n = 9) and additional partial (1) CPSS attenuation. Results-Degree of opacification of the intrahepatic portal vessels increased significantly (higher portovenogram grade) after CPSS attenuation. The median portovenogram grade assigned after temporary shunt occlusion at the first surgery was significantly higher in cats that did not have postattenuation neurologic complications or neurologic signs at follow-up than in cats that did. It was also higher in cats that had a better clinical response to surgery versus those that had a poor response and in cats with reduced preprandial and postprandial serum bile acids concentrations at follow-up versus those that did not. Conclusions and Clinical Relevance-IMP may be used to help predict complications and outcome following surgical treatment of CPSS in cats. (J Am Vet Med Assoc 2009;234: 221-228)