title: Long-term survival and quality of life in dogs with clinical signs associated with a congenital portosystemic shunt after surgical or medical treatment.
abstract: OBJECTIVE
  To compare long-term survival and quality of life data in dogs with clinical signs associated with a congenital portosystemic shunt (CPSS) that underwent medical or surgical treatment.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  124 client-owned dogs with CPSS.
  
  
  METHODS
  Dogs received medical or surgical treatment without regard to signalment, clinical signs, or clinicopathologic results. Survival data were analyzed with a Cox regression model. Quality of life information, obtained from owner questionnaires, included frequency of CPSS-associated clinical signs (from which a clinical score was derived), whether owners considered their dog normal, and (for surgically treated dogs) any ongoing medical treatment for CPSS. A Mann-Whitney U test was used to compare mean clinical score data between surgically and medically managed dogs during predetermined follow-up intervals.
  
  
  RESULTS
  97 dogs underwent surgical treatment; 27 were managed medically. Median follow-up time for all dogs was 1,936 days. Forty-five dogs (24 medically managed and 21 surgically managed) died or were euthanized during the follow-up period. Survival rate was significantly improved in dogs that underwent surgical treatment (hazard ratio, 8.11; 95% CI, 4.20 to 15.66) than in those treated medically for CPSS. Neither age at diagnosis nor shunt type affected survival rate. Frequency of clinical signs was lower in surgically versus medically managed dogs for all follow-up intervals, with a significant difference between groups at 4 to 7 years after study entry.
  
  
  CONCLUSIONS
  Surgical treatment of CPSS in dogs resulted in significantly improved survival rate and lower frequency of ongoing clinical signs, compared with medical management. Age at diagnosis did not affect survival rate and should not influence treatment choice.
authors.affiliation: Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, England.
authors.forename: Stephen N
authors.initials: SN
authors.lastname: Greenhalgh
authors.forename: Jenny A
authors.initials: JA
authors.lastname: Reeve
authors.forename: Thurid
authors.initials: T
authors.lastname: Johnstone
authors.forename: Mark R
authors.initials: MR
authors.lastname: Goodfellow
authors.forename: Mark D
authors.initials: MD
authors.lastname: Dunning
authors.forename: Emma J
authors.initials: EJ
authors.lastname: O'Neill
authors.forename: Ed J
authors.initials: EJ
authors.lastname: Hall
authors.forename: Penny J
authors.initials: PJ
authors.lastname: Watson
authors.forename: Nick D
authors.initials: ND
authors.lastname: Jeffery
mesh_terms: D000818:Animals; D015331:Cohort Studies; D004283:Dog Diseases / Q000151:congenital* / Q000401:mortality / Q000628:therapy; D004285:Dogs; D005260:Female; D008107:Liver Diseases / Q000151:congenital / Q000401:mortality / Q000628:therapy / Q000662:veterinary*; D008297:Male; D011168:Portal System / Q000002:abnormalities* / Q000601:surgery