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The introduction of intravascular coil embolisation has now been added to our increasingly popular interventional radiology service. Interventional radiology is run by a team comprising specialists from internal medicine, cardiology and soft tissue surgery, each bringing expertise in their own field to achieve the best possible outcomes for the animals in their care.
Intrahepatic portosystemic shunts represent a particular challenge due to their large size, fragility and location within the liver. Open surgical treatment of intrahepatic shunts has been associated with relatively high risk of perioperative mortality.
Intravenous coil embolisation is rapidly becoming the standard of care for treatment of intrahepatic portosystemic shunts, particularly those involving the central and right division where surgical access can be especially challenging. The lack of requirement for hazardous dissection results in increased safety when compared to open surgery and its minimally invasive nature results in a faster recovery from surgery.
Long term outcomes of intravascular embolisation in terms of reduction in shunt blood flow are similar to those achieved by open surgery*.
Following referral of a dog with a suspected intrahepatic shunt, we would usually recommend an initial assessment of the anatomy to help decide which treatment options are suitable. Most cases are medically managed for a period of time prior to surgery.
In the event that coil embolisation is selected as the treatment of choice, dogs will need to wait until they are at least 10-12 months old to ensure they are fully grown before the caudal vena cava is measured to allow placement of a specifically sized stent. In some cases this can require an additional measuring CT scan approximately two weeks before the planned date of surgery.
As is the case for open surgical management of intrahepatic portosystemic shunts, many dogs undergoing minimally invasive surgery continue to have some flow though the abnormal vessel. However, in most dogs this does not require additional treatment as the shunt fraction is low enough not to significantly affect their quality of life or require ongoing medical management. In a small proportion of dogs further benefit can be obtained by placement of additional coils at a later date once the system had adjusted to the initial alteration of flow.
Video of coil deployment
*Weisse C, Berent AC, Todd K, Solomon JA, Cope C. (2014) Endovascular evaluation and treatment of intrahepatic portosystemic shunts in dogs: 100 cases (2001-2011). J Am Vet Med Assoc. 1:244(1):78-94