Percutaneous transvenous coil embolisation as treatment for intrahepatic portosystemic shunts
Abstract
Intrahepatic portosystemic shunts often occur due to failure of the ductus venous to close after birth. Surgical treatment of this anomaly historically involved acute closure of the vessel by ligation which would lead to a high morbidity rate due to the risk of portal hypertension. Percutaneous transvenous coil embolisation (PTCE) is a method of gradual occlusion of the shunting vessel thus aiming to avoid acute rises in portal venous pressure.
This article will discuss the use of this procedure compared with other methods as well as pre, peri and post-operative care of patents who have received PTCE.
Portosystemic shunts (PSS) are defined as vessels that allow portal blood to drain from the stomach, intestines, pancreas and spleen directly into the systemic circulation thus bypassing the liver (Fossum, 2007). They can be extrahepatic, occurring outside of the hepatic system, or intrahepatic, occurring within the hepatic portal system. It is the surgical treatment of intrahepatic portosystemic shunts (IHPSS), mainly occlusion of the shunting vessel by percutaneous transvenous coil embolisation (PTCE), that will be the main focus of this article.
IHPSS are normally congenital, left sided and thought to be a result of failure of the closure of the ductus venosus with large purebreed dogs, such as Golden Retrievers, Irish Setters and Irish Wolfhounds, being over represented (Burton et al, 1998). Clinical signs of PSS (Table 1) vary according to the amount of blood that is bypassing the liver. IHPSS normally involve a great amount of blood bypassing the liver which can explain why the diagnosis is often made in younger animals with mild to severe clinical signs (Berent and Wiesse, 2007)
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