Re-evaluation of a portocaval venograft without an ameroid constrictor as a method for controlling portal hypertension after occlusion of intrahepatic portocaval shunts in dogs.
OBJECTIVE
To evaluate the use of a portocaval venograft without an ameroid constrictor in the surgical management of intrahepatic portosystemic shunts (PSS).


METHODS
Prospective clinical study.


METHODS
Seven dogs with intrahepatic PSS.


METHODS
Portal pressure was measured after temporary suture occlusion of the intrahepatic PSS. In dogs with an increase in portal pressure > or =8 mm Hg or signs of portal hypertension, a single extrahepatic portocaval shunt was created using a jugular vein. Clinical outcome and complications were recorded.


RESULTS
The mean (+/-SD) portal pressure increased from 5.9+/-1.6 to 17.9+/-4.1 mm Hg with PSS occlusion. There were no intraoperative complications and, after creation of the portocaval shunt, the intrahepatic PSS could be completely ligated in all dogs. The final portal pressure was 9.6+/-1.9 mm Hg. Complications developed during postoperative hospitalization in 5 dogs and included incisional discharge (4 dogs), ascites (3), ventricular premature contractions (2), and melena, bloody diarrhea, neurologic signs, coagulopathy, and aspiration pneumonia (each in 1 dog). Six dogs died or were euthanatized with clinical signs related to depression, inappetance, abdominal pain, vomiting, melena, and abdominal distention, with a median survival of 82 days (range, 20-990 days). One dog was clinically normal at 33 months after surgery.


CONCLUSIONS
Clinical signs observed in 6 dogs after surgery were consistent with portal hypertension. Use of a portocaval venograft without an ameroid constrictor may reduce the likelihood of hepatic vascular development, thereby increasing the risk of life-threatening portal hypertension should the venograft suddenly occlude.


CONCLUSIONS
Use of a portocaval venograft without an ameroid constrictor to control portal hypertension after ligation of an intrahepatic PSS cannot be recommended.
Kyles
Andrew E
AE
Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA. aekyles@ucdavis.edu
Gregory
Clare R
CR
Adin
Christopher A
CA
D000818:Animals; D001672:Biocompatible Materials; D002364:Caseins; D004283:Dog Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004285:Dogs; D005260:Female; D005431:Florida; D020100:Hydrogels; D006975:Hypertension, Portal / Q000601:surgery / Q000662:veterinary*; D008026:Ligation / Q000295:instrumentation / Q000662:veterinary; D008297:Male; D011167:Portacaval Shunt, Surgical / Q000662:veterinary; D011183:Postoperative Complications; D011446:Prospective Studies
D001672:Biocompatible Materials; D002364:Caseins; D020100:Hydrogels; C009719:ameroid