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SCVS Lead The Way With Intra-hepatic Portosystemic Shunts

11 months ago
660 views

Posted
1st May, 2019 16h16

Author
Southern Counties Veterinary Specialists


The already established and experienced cardiovascular interventional service at Southern Counties Veterinary Specialists is expanding and can now offer minimal invasive, interventional closure of intra-hepatic portosystemic shunts.

SCVS are now in a position to offer interventional, coil embolisation of intra-hepatic portosystemic shunts using a novel technique not being performed elsewhere in the UK. This technique was developed at the University of Giessen, Germany, by one of the most experienced veterinary interventionalists in mainland Europe. Specialists at SCVS have gained access to this novel technique by working with the staff at the University of Giessen and are excited to now offer the procedure at our established facility.

An intra-hepatic portosystemic shunt is a congenital abnormality affecting the vasculature of the liver. While single, extra-hepatic shunt vessels are encountered more commonly than intra-hepatic variants, intra-hepatic shunts may account for up to ~30% of congenital hepatic vascular anomalies in dogs. The often complex anatomy and position of intra-hepatic shunt vessels makes them less amenable to surgical attenuation when compared to the extra-hepatic variant and interventional closure of the shunt vessel is usually the treatment of choice.

The novel technique offered at SCVS avoids the need for stent placement within the caudal vena cava and closes the shunt at a different level compared to the stent & coil technique. This avoids the risk of the development of collateral veno-venous shunts which is a reported problem in the stent & coil embolization technique.

The hepatic vasculature is approached through an access catheter placed within the jugular vein. A single, large coil is carefully positioned within the shunt vessel with portal pressures and blood flow checked before, during and after coil placement. A complex and well tested heparinisation protocol allows for controlled closure of the shunt vessel avoiding complications of severe portal hypertension and allowing gradual complete shunt closure in most patients even if only very little portal branching is present. Complete shunt closure is important for a good long term outcome. The novel aspects of this technique lead to relatively low complication and high success rates. With the cardiology, internal medicine and radiology service working closely together to offer this procedure at SCVS, all patients get a truly multidisciplinary approach with gold standard care and advice offered before, during and after the procedure.

Other interventional / minimally invasive procedures offered at SCVS include:

Cardiology

Respiratory

Gastrointestinal


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