![]() On initial examination, decreased level of consciousness and generalized seizures were evident. ![]() Plasma ammonia (PA) concentration taken at the referring clinic had been elevated (> 587 μmol/L), and the animal was brought to TUATAMC for further investigation (Day 1). Two days before the initial hospital visit, the animal exhibited loss of both vigor and appetite, altered consciousness, and convulsive seizures. In addition, the sheath acts not only for placement of the device, but also as a catheter for the measurement of PV pressure and the injection of contrast agent.Ī 10-month-old neutered male exotic shorthaired cat was referred to the Tokyo University of Agriculture and Technology Animal Medical Center (TUATAMC) because of drooling after meals that had appeared 2 mo previously. Because this procedure is conducted under direct visualization of the organs inside the abdomen, intestinal color and peristaltic movement after coil implantation are easily evaluated, and liver biopsy can be readily and safely conducted. The distance between the sheath and shunt vessel is short, facilitating more accurate maneuvering of the catheter tip. In addition, no dissection of the hepatic parenchyma is required. The incision for the surgical site is relatively small, and the risk of adhesion is minimal. The HST requires a surgical approach only around the main trunk of the PV or mesenteric vein. This approach was chosen for the following reasons based on our experience with canine and feline cases of PSS requiring stepwise closure. The hybrid surgical technique (HST) represents a combination of conventional open surgery and interventional radiology. In addition, based on our personal experience, measuring portal vein (PV) pressure and performing angiography after shunt vessel occlusion in PTCE is sometimes difficult in cats. Size of the device in cats is restricted by the smaller body conformation and vascular diameter, so PTCE has been applied in only a limited number of cases. In those previous reports, jugular, femoral, or saphenous veins were used as approach sites. Percutaneous transvenous coil embolization (PTCE) has been used for both dogs ( 11, 15) and cats ( 5) in an attempt to resolve the issues associated with conventional surgery. An approach other than conventional surgery is thus desirable. In our experience, when attempting surgical ligation, multiple approaches to the shunting vessel are sometimes difficult because of adhesions caused by the earlier approaches. Stepwise closure of the shunting vessel is therefore recommended in such cases ( 12). Attempting to achieve complete occlusion of the shunt in a single procedure under these circumstances sometimes causes portal hypertension, which in turn can cause ascites, postoperative development of multiple shunts, intestinal injury, or even death. Microhepatia is seen in half of feline cases of intra- and extrahepatic PSS ( 2), and large-diameter shunts usually show a higher volume of blood flow. With the exception of cellophane banding, these methods are also used for intrahepatic shunt vessels ( 1, 3, 4, 14). Previous methods of treating extrahepatic portosystemic shunts in cats have included the use of surgical ligation ( 1, 3, 10, 11), ameroid constrictors ( 12), and cellophane banding ( 7, 13). Such operative stresses can occasionally prove fatal for kittens ( 9). The main method of treatment for feline PSS is surgical ligation ( 3), but dissection of the liver parenchyma to identify the shunting vessel can be challenging with intrahepatic PSS (IHPSS), in which a direct approach to the shunting vessel is anatomically difficult. Because cats with PSS and neurological symptoms treated medically are reported to die within 2 y following diagnosis ( 8), surgery is often required at an early age. The mean body weight (BW) at diagnosis is also low, reportedly ranging from 1.2 to 2.9 kg for intrahepatic cases (mean: 2.3 kg) ( 4, 5) and from 1.1 to 6.2 kg for extrahepatic cases (mean: 2.9 kg) ( 6, 7). Feline PSS is usually identified at a young age, with a mean age at diagnosis of 4 to 9 mo ( 1– 3). Ideal methods of treatment have yet to be established in dogs or cats. ![]() Unlike cases of portosystemic shunt (PSS) in canines, cases of feline PSS are rare ( 1).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |