• Journal of Veterinary Clinics
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• v.24 no.3
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• pp.461-466
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• 2007

Two dogs were admitted with a history of anorexia, ataxia, shivering, lethargy, hypersalivation and seizure. Patients were suspected for portosystemic shunts on the basis of clinical signs, increased hepatic serum profiles on the blood test, microhepatica on plain abdominal radiographs, and an abnormally dilated and tortuous vessel on abdominal ultrasonographs. To diagnose PSS and to further evaluate type, shape, and location of shunt and hepatic vasculatures, the computed tomography (CT) angiography for portal and systemic circulation was performed. The shape, location and pathway of extrahepatic single shunt were confirmed in two dogs. Dual phases (the arterial phase and the venous phase) CT angiography and reformatted and three-dimensional images offered good understanding of PSS and planning surgical treatment.

• Korean Journal of Veterinary Research
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• v.58 no.4
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• pp.227-230
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• 2018

A 2-year-old, spayed female, Korean domestic short-hair cat was presented with depression and vomiting. The patient had history of weight loss lasting seven months. Physical examination revealed icterus in the pinna, oral mucosa, and sclera. Based on ultrasonography and computed tomography, tentative diagnosis was extrahepatic biliary tract obstruction with acquired portosystemic shunt (PSS). Tumor or inflammation of hepatobiliary system was suspected as the cause of obstruction of the common bile duct. But it could not be determined without biopsy. The severely dilated cystic duct was considered to cause portal hypertension and secondary multiple PSS. The patient expired without histopathologic examination.

• Journal of the Korean Society of Radiology
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• v.83 no.6
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• pp.1426-1431
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• 2022

Intrahepatic portosystemic venous shunt (IPSVS) is a rare vascular abnormality that involves abnormal communication between the intrahepatic portal vein and systemic veins, such as the hepatic vein or inferior vena cava. Patients with IPSVS are typically asymptomatic, and IPSVS is incidentally discovered via imaging while evaluating other diseases. However, endovascular closure of the shunt should be considered in symptomatic patients with a high-flow shunt. This report presents a patient with congenital IPSVS with sudden onset hepatic encephalopathy treated using percutaneous transhepatic embolization.

• Journal of Veterinary Clinics
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• v.37 no.4
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• pp.227-230
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• 2020

A 8-year-old spayed female Korean short-haired cat was presented with respiratory distress. CBC, serum chemistry analysis, plain radiography, and abdominal ultrasonography were performed. Besides hypertrophic cardiomyopathy (HCM) suspected by the thoracic radiograph, a tubular, tortuous soft tissue structure was detected at the region of the left retroperitoneal cavity on the abdominal radiograph. On the abdominal ultrasonography, a shunt vessel is identified caudo-lateral to the left kidney region. These findings are consistent with spleno-systemic shunts in cats. Furthermore, portal hypertension and diffuse hepatic lesion were also identified. Although the cause of a shunt vessel is not easy to diagnose, it is important to include spleno-systemic shunt into differential diagnosis list, when convoluted, tubular soft tissue opacity is seen on the digital radiography (DR). This report will allow clinicians to raise awareness of complications of portosystemic shunt (PSS) and better treat PSS suspected feline patients when the advanced modalities such as computed tomography and magnetic resonance imaging are not available.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.25 no.2
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• pp.147-162
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• 2022

Purpose: To design a prospective study on endovascular closure of congenital portosystemic shunts. The primary endpoint was to assess the safety of endovascular closure. The secondary endpoint was to evaluate the clinical, analytical and imaging outcomes of treatment. Methods: Fifteen patients (age range: 2 days to 21 years; 10 male) were referred to our center due to congenital portosystemic shunts. The following data were collected prior to treatment: age, sex, medical history, clinical and analytical data, urine trimethylaminuria, abdominal-US, and body-CT. The following data were collected at the time of intervention: anatomical and hemodynamic characteristics of the shunts, device used, and closure success. The following data were collected at various post-intervention time points: during hospital stay (to confirm shunt closure and detect complications) and at one year after (for clinical, analytical, and imaging purposes). Results: The treatment was successful in 12 participants, migration of the device was observed in two, while acute splanchnic thrombosis was observed in one. Off-label devices were used in attempting to close the side-to-side shunts, and success was achieved using Amplatzer™ Ductus-Occluder and Amplatzer™ Muscular-Vascular-Septal-Defect-Occluder. The main changes were: increased prothrombin activity (p=0.043); decreased AST, ALT, GGT, and bilirubin (p=0.007, p=0.056, p=0.036, p=0.013); thrombocytopenia resolution (p=0.131); expansion of portal veins (p=0.005); normalization of Doppler portal flow (100%); regression of liver nodules (p=0.001); ammonia normalization (p=0.003); and disappearance of trimethylaminuria (p=0.285). Conclusion: Endovascular closure is effective. Our results support the indication of endovascular closure for side-to-side shunts and for cases of congenital absence of portal vein.

• Journal of Veterinary Clinics
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• v.29 no.6
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• pp.488-493
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• 2012

Two Maltese (2-year-old, intact female and 4-month-old, intact female) and a Pekingese (10-year-old, intact male) dogs were referred due to vomiting, anorexia, head-pressing and hypersalivation. Physical examinations, complete blood count, serum chemical analysis, radiography, ultrasonography and computed tomography (CT) were evaluated. Laboratory findings in these dogs included high hepatic enzyme, serum bile acid and ammonia concentration. Microhepatia was found on abdominal radiographs in two dogs. The existence of portosystemic shunt was presented in abdominal ultrasonography. The shunt vessel was identified in all dogs by CT imaging. Based on three-dimensional CT reconstruction, the origin and termination of each shunt vessel were defined certainly. In consequence, each dog was diagnosed single extrahepatic portosystemic shunt. After diagnosis, surgical treatment was performed in all dogs. This case report describes clinical finding, imaging characteristics, and three-dimensional CT imaging of single extrahepatic portosystemic shunt cases.

• Journal of Veterinary Clinics
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• v.24 no.3
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• pp.426-431
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• 2007

A 5-month-old female Samoyed dog was presented with primary complaints including exercise tolerance and neurological sign associated with hepatic encephalopathy. The major findings in clinical examination included an intermittent seizure, anemia, elevated pre- and post-prandial serum bile acid, hypoproteinemia and bilirubinuria. Diagnostic imaging studies revealed an intrahepatic portosystemic shunt (IPSS). The shunted vessel was successfully occluded by transvenous coil embolization. Clinical signs were gradually improved after shunt occlusion. This case is a rare case of IPSS in a large breed dog fixed by transvenous coil embolization.

• Korean Journal of Radiology
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• v.2 no.4
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• pp.204-209
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• 2001

Objective: To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) in patients with occluded previous TIPS. Materials and Methods: Between February 1996 and December 2000 we performed five transcaval TIPS procedures in four patients with recurrent gastric cardiac variceal bleeding. All four had occluded TIPS, which was between the hepatic and portal vein. The interval between initial TIPS placement and revisional procedures with transcaval TIPS varied between three and 31 months; one patient underwent transcaval TIPS twice, with a 31-month interval. After revision of the occluded shunt failed, direct cavoportal puncture at the retrohepatic segment of the IVC was attempted. Results: Transcaval TIPS placement was technically successful in all cases. In three, tractography revealed slight leakage of contrast materials into hepatic subcapsular or subdiaphragmatic pericaval space. There was no evidence of propagation of extravasated contrast materials through the retroperitoneal space or spillage into the peritoneal space. After the tract was dilated by a bare stent, no patient experienced trans-stent bleeding and no serious procedure-related complications occurred. After successful shunt creation, variceal bleeding ceased in all patients. Conclusion: Transcaval TIPS placement is an effective and safe alternative treatment in patients with occluded previous TIPS and no hepatic veins suitable for new TIPS.

• Gut and Liver
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• v.12 no.6
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• pp.704-713
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• 2018

Background/Aims: Gastric varices (GVs) are a major cause of upper gastrointestinal bleeding in patients with liver cirrhosis. The current treatments of choice are balloon-occluded retrograde transvenous obliteration (BRTO) and the placement of a transjugular intrahepatic portosystemic shunt (TIPS). We aimed to compare the efficacy and outcomes of these two methods for the management of GV bleeding. Methods: This retrospective study included consecutive patients who received BRTO (n=157) or TIPS (n=19) to control GV bleeding from January 2005 to December 2014 at a single tertiary hospital in Korea. The overall survival (OS), immediate bleeding control rate, rebleeding rate and complication rate were compared between patients in the BRTO and TIPS groups. Results: Patients in the BRTO group showed higher immediate bleeding control rates (p=0.059, odds ratio [OR]=4.72) and lower cumulative rebleeding rates (logrank p=0.060) than those in the TIPS group, although the difference failed to reach statistical significance. There were no significant differences in the rates of complications, including pleural effusion, aggravation of esophageal varices, portal hypertensive gastropathy, and portosystemic encephalopathy, although the rate of the progression of ascites was significantly higher in the BRTO group (p=0.02, OR=7.93). After adjusting for several confounding factors using a multivariate Cox analysis, the BRTO group had a significantly longer OS (adjusted hazard ratio [aHR]=0.44, p=0.01) and a longer rebleeding-free survival (aHR=0.34, p=0.001) than the TIPS group. Conclusions: BRTO provides better bleeding control, rebleeding-free survival, and OS than TIPS for patients with GV bleeding.

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2007.05a
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• pp.146-146
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• 2007