OBJECTIVE:To evaluate short- and long-term outcomes and health-related quality of life (Hr-QoL) in dogs with congenital intrahepatic portosystemic shunts (cIHPSS) treated using percutaneous transcatheter embolization (PTCE). STUDY DESIGN:Single center retrospective and prospective study. ANIMALS:Sixty-one client-owned dogs. METHODS:Medical records were reviewed, and owners completed validated Hr-QoL and congenital portosystemic shunt scoring (Hr-CPSS) questionnaires. Hr-QoL scores ranged from 0 (worst) to 100 (best), and Hr-CPSS from 0 (best) to 100 (worst). Survival was assessed using Kaplan-Meier analysis. Medical or dietary management at final follow-up were recorded. RESULTS:Median follow-up time was 769 days (interquartile range [IQR]: 297-1865). Median survival time was 1496 days. At last follow-up, 33 of 59 dogs remained on medical management and/or a specialized diet. Median Hr-CPSS significantly decreased from prediagnosis (25 [IQR: 18-51.3]) to post-PTCE (5 [IQR: 3-11]; p < .001), but not between post-medical and post-PTCE (p = .68). Median Hr-QoL scores improved post-PTCE (100 [IQR: 80-100]) compared to prediagnosis (35 [IQR: 10-50], p < .0001), and post-medical (75 [IQR: 40-90], p = .005) as well as between prediagnosis and post-medical (p = .038). One-, two-, and five-year survival rates were 83%, 66%, and 54%, respectively. CONCLUSION:Treatment of cIHPSS with PTCE in dogs was associated with a good long-term survival and significant improvement in QoL and clinical signs. IMPACT:The combination of PTCE and targeted medical management provides an effective minimally invasive treatment option for dogs with cIHPSS, supporting improved longevity and quality of life.

Objectives To report clinical presentation, short‐term outcome and complications of tracheal resection and anastomosis in dogs and cats. Materials and Methods Clinical records of pets treated with tracheal resection and anastomosis in seven UK‐based veterinary referral centres were retrospectively reviewed (2009 to 2022). Results Twenty client‐owned pets (eight dogs; 12 cats) were included. Clinical signs comprised dyspnoea ( n = 15), stridor ( n = 5), subcutaneous emphysema ( n = 3), pneumothorax and pneumomediastinum ( n = 1), coughing ( n = 3), regurgitation ( n = 1) and exercise intolerance ( n = 1). Indication for surgery was traumatic tracheal rupture ( n = 5), tracheal avulsion ( n = 7), neoplasia ( n = 5) and stenosis ( n = 3). Complications occurred in 15 patients (75%). Non‐anastomotic complications occurred in nine patients and consisted of cough ( n = 5), self‐resolving laryngeal paralysis ( n = 1), surgical site infection ( n = 1) and septic shock ( n = 2). Anastomotic complications occurred in seven patients and consisted of anastomotic dehiscence ( n = 1), tracheal stenosis ( n = 4) and fatal respiratory failure ( n = 2). Revision surgery was performed in two dogs due to anastomotic dehiscence and stenosis, and tracheal stenting was performed in one cat due to stenosis. Sixteen patients survived to hospital discharge and 14 survived to latest follow‐up (median: 119 days; range: 14 to 1744). Outcome was scored as excellent in five, good in seven, fair in two and poor in six patients. Clinical Significance Tracheal resection and anastomosis is the surgical technique of choice to reconstruct tracheal defects. Although more than half of the patients recovered well, high morbidity and mortality rates were documented. This may be due to the severe comorbidities affecting most tracheal resection and anastomosis patients, as well as the client's decision against further treatment when facing serious post‐operative complications.

Case series summary The objective of this case series was to describe the presentation, surgical treatment and outcome of a congenital intrahepatic portosystemic shunt (IHPSS) in 12 cats. A retrospective case series of cats undergoing surgical treatment for an IHPSS was undertaken. Signalment, clinical signs, imaging, surgical treatment, complications and short-term outcome (<30 days) were obtained using medical records. Long-term outcome (>1 year after first surgery) was obtained, where possible, using a health-related quality of life owner questionnaire. Seven cats were diagnosed with a left divisional shunt, three with a central divisional shunt and two with a right divisional shunt using intraoperative mesenteric portovenography. Three cats tolerated complete acute suture attenuation, eight cats underwent partial suture attenuation, four of which received complete suture ligation at a second surgery, and one cat underwent partial attenuation with a thin film band. Six cats (50%) developed post-attenuation neurological signs (PANS) after first surgery and two cats (17%) died or were euthanased due to severe PANS. Long-term outcome was available for eight cats (67%), with a median follow-up time of 1743 days (range 364–2228), and was described as excellent in five cats (63%), fair in two cats (25%) and poor in one cat (12%). Relevance and novel information Few papers exist that describe the presentation, intraoperative imaging, treatment and outcome of IHPSSs in cats. This is the first to describe surgical attenuation with a thin film band in a cat with an IHPSS. This case series reports excellent long-term outcomes in a majority of surgically treated cats with IHPSS.

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BACKGROUND:Congenital portosystemic shunt (cPSS) is one of the most common congenital disorders diagnosed in dogs. Hepatic encephalopathy (HE) is a frequent complication in dogs with a cPSS and is a major cause of morbidity and mortality. Despite HE been a major cause of morbidity in dogs with a cPSS, little is known about the cellular changes that occur in the central nervous system of dogs with a cPSS.OBJECTIVES:The objective of this study was to characterise the histological changes in the cerebral cortex and cerebellum of dogs with cPSS with particular emphasis on astrocyte morphology.METHODS:Eight dogs with a confirmed cPSS were included in the study.RESULTS:Six dogs had substantial numbers of Alzheimer type II astrocytes and all cases had increased immunoreactivity for glial fibrillary acidic protein in the cerebral cortex, even if there were minimal other morphological changes.CONCLUSIONS:This study demonstrates that dogs with a cPSS have marked cellular changes in the cerebral cortex and cerebellum. The cellular changes that occur in the cerebral cortex and cerebellum of dogs with spontaneously arising HE are similar to changes which occur in humans with HE, further validating dogs with a cPSS as a good model for human HE.

Objectives To describe the presentation, treatment and outcome of unilateral and bilateral ureter injuries resulting from ovariohysterectomy complications in cats and dogs. Materials and Methods Retrospective case series of cats and dogs with ureteric injuries resulting from an ovariohysterectomy complication. Patient signalment, history, presenting clinical signs, clinical pathology, imaging, diagnosis, treatment and outcome were obtained from the medical records and telephone contact with the owners. Results Fourteen female cats and five female dogs were included. Eleven (58%) exhibited clinical signs immediately after recovery from ovariohysterectomy, six (32%) had a median onset of clinical signs of 3 days (range 1 to 16 days), and two (10%) were referred immediately because of a known complication during surgery. Five of seven animals with bilateral ureter injury presented with anuria. Three animals died or were euthanased without definitive surgery. Surgical repair surgeries included ureteroneocystostomy (eight cats, one dog), ureteronephrectomy (four cats, two dogs), subcutaneous ureteral bypass placement (three cats) and ureteral stent (one cat). Of the 16 operated animals, seven (44%) that were discharged from the hospital experienced major complications requiring one or more additional surgeries. Overall outcome was excellent in 13 (68%), good in one (5%), fair in one (5%) and poor in four (22%) animals. Clinical Significance A key indicator of a ureteric injury is an animal failing to recover normally or becoming unwell shortly after ovariohysterectomy. Anuria is likely in animals with bilateral ureter injury. Excellent outcomes are possible following surgical treatment.

A kitten presented with acute kidney injury, bilateral hydronephrosis and proximal hydroureter, three days following bilateral ureteral ligation, during a complicated ovariohysterectomy procedure. Clinical signs were anorexia, lethargy, weakness, hypothermia, nausea, pain and anuria, associated with marked azotaemia, hyperkalaemia and metabolic acidosis. Insufficient response to medical management alone led to emergency surgical placement of bilateral subcutaneous ureteral bypass (SUB) systems, resulting in dramatic improvement in azotaemia and acidosis and resolution of hyperkalaemia. Elective bilateral neoureterocystostomy was performed the next day. The cat was clinically well for three months until the left SUB cystostomy catheter migrated out of the bladder resulting in uroabdomen. At this time, fluoroscopy demonstrated normal ureteral function bilaterally, so both SUBs were removed. Following recovery from surgery the cat has remained clinically normal. This report highlights the possibility of temporary SUB placement as a bridge to definitive ureteral repair in cases of accidental ureteral ligation.

Objectives To identify CT features of canine hepatic masses that could be used to determine their divisional or lobar origin. Materials and Methods Preoperative, postcontrast CT images of 57 surgically resected hepatic masses were reviewed with respect to their size, position relative to the midline, gallbladder and portal vein, nearest recognisable hepatic lobar vein or portal vein and point of contact with the diaphragm and displacement of adjacent organs. Results The most prevalent histological diagnoses were hepatocellular carcinoma (n=26; 46%) and adenoma (n=10; 18%). Based on surgical assessment, it was observed that masses originated in the left hepatic division in 30 (53%) instances, central division in seven (12%) and right division in 20 (35%). All masses to the left of midline were left divisional, but only 18/30 (60%) masses to the right of midline were right divisional. Most (26/31; 84%) masses to the left of the gallbladder were left divisional and 84% (16/19) masses to the right of the gallbladder were right divisional. Half (10/20; 50%) of the right-divisional masses were medial, lateral or dorsal to the portal vein, but all other hepatic masses were ventral to the portal vein. A hepatic lobar vein or portal vein branch adjacent to the mass was observed in 53 (93%) instances; this feature correlated with surgical assessment of the affected division in 53 (93%) hepatic masses and the affected lobe in 32 (56%). Clinical Significance Combining CT features of hepatic masses appears to be an accurate method for determining their divisional or lobar origin.

OBJECTIVES:To design a health-related quality of life questionnaire for dogs with congenital portosystemic shunts, use it in a cohort of dogs treated with suture attenuation and compare results with those obtained from a healthy control cohort.MATERIALS AND METHODS:Data were collected from the hospital records of dogs treated with suture ligation of an intrahepatic or extrahepatic congenital portosystemic shunt at two referral centres. Owners were asked to complete a questionnaire assessing their dog's health-related quality of life preoperatively (retrospectively) and at the time of follow-up. Owners of control dogs also completed the questionnaire.RESULTS:One hundred and twenty-eight dogs with congenital portosystemic shunts and 131 control dogs were recruited. Median follow-up time was 64 months (range 19.7 to 157.2). The median long-term health-related quality of life score was excellent for both intrahepatic and extrahpatic shunt cases and similar to that of control dogs. The long-term portosystemic shunt clinical sign scores for both intrahepatic and extrahepatic congenital portosystemic shunt dogs were significantly worse than the those of the control group.CLINICAL SIGNIFICANCE:Suture attenuation of congenitial portosystemic shunts is associated with an excellent health-related quality of life score at long-term follow-up.

OBJECTIVES:To report the long-term bile acid stimulation test results for dogs that have undergone complete suture ligation of a single congenital extrahepatic portosystemic shunt.MATERIALS AND METHODS:Data were collected from the hospital records of all dogs that had undergone a complete suture ligation of a single congenital extrahepatic portosystemic shunt. Owners were invited to return to the referral centre or their local veterinarian for repeat serum bile acid measurement. Dogs diagnosed with idiopathic epilepsy and undergoing bile acid stimulation tests were used as a comparison population.RESULTS:Fifty-one study dogs were included, with a mean follow-up time of 62 months. 48 dogs had no evidence of multiple acquired shunts and a significant reduction in the pre- and post-prandial serum bile acid concentrations at long-term follow-up compared with pre-operative measurements. Pre- and post-prandial serum bile acids were statistically significantly greater for dogs that had undergone a full ligation (with no evidence of multiple acquired shunts) at all time points compared to the control dogs (P<0·001 for all comparisons).CLINICAL SIGNIFICANCE:The results suggest that in dogs treated with complete suture ligation mild increases in serum bile acids are not clinically relevant if there are no physical examination abnormalities, a normal body condition score and no relapse in clinical signs.

The aim of this study was to establish the evidence base for the treatment of intrahepatic congenital portosystemic shunts in dogs through a systematic review of the pertinent literature. Studies were filtered for evidence to answer the question "Which of the treatment options for intrahepatic CPSS in dogs offers the best short- and long-term outcome?" Studies were assigned a level of evidence based on a system published by the Oxford Centre for Evidence-Based Medicine. Thirty-two studies were included in the review. Twenty-six provided level 4 evidence and six provided level 5 evidence. There were no level 1, 2 or 3 studies. One study compared surgical treatment with medical management and one study compared suture ligation with ameroid constrictor placement. The remaining studies were case series describing the outcome for one treatment method alone. Methods and timings of assessments of short- and long-term outcomes were highly varied, making direct comparisons challenging. The evidence regarding the treatment of intrahepatic congenital portosystemic shunts in dogs is weak, with only two studies directly comparing treatments. There is a lack of evidence regarding short- and long-term outcomes on which to base clinical decisions.

Objectives The objectives of this study were, first, to report the haematological parameters and coagulation times for cats with a congenital portosystemic shunt (CPSS) and the influence of surgical shunt attenuation on these parameters; and, second, to identify any association between prolongation in coagulation profiles and incidence of perioperative haemorrhage. Methods This was a retrospective clinical study using client-owned cats with a CPSS. Signalment, shunt type (extra- or intrahepatic), degree of shunt attenuation (complete or partial), haematological parameters, prothrombin time (PT) and activated partial thromboplastin time (aPTT) test results, and occurrence of any perioperative clinical bleeding complications were recorded for cats undergoing surgical treatment of a CPSS at the Royal Veterinary College, UK, between 1994 and 2011. Results Forty-two cats were included. Thirty-six (85.7%) had an extrahepatic CPSS and six (14.3%) had an intrahepatic CPSS. Preoperatively, mean cell volume (MCV) and mean cell haemoglobin (MCH) were below the reference interval (RI) in 32 (76.2%) and 31 (73.8%) cats, respectively. Red blood cell count and mean cell haemoglobin concentration (MCHC) were above the RI in 10 (23.8%) and eight (19.1%) cats, respectively. Postoperatively, there were significant increases in haematocrit (P = 0.044), MCV (P = 0.008) and MCH (P = 0.002). Despite the significant increase in MCV postoperatively, the median MCV postoperatively was below the RI, indicating persistence of microcytosis. Preoperatively, PT was above the upper RI in 14 cats (87.5%), and aPTT was above the upper RI in 11 cats (68.8%). No cat demonstrated a perioperative clinical bleeding complication. Conclusions and relevance Cats with a CPSS are likely to present with a microcytosis, but rarely present with anaemia, leukocytosis or thrombocytopenia. Surgical attenuation of the CPSS results in a significant increase in the HCT and MCV. Coagulation profiles in cats with a CPSS are likely to be prolonged, irrespective of shunt type, but do not appear to be associated with an increased risk of clinical bleeding.

CASE SUMMARY:A 15-year-old female cat was presented for investigation of progressive behavioural changes, polyuria, polydipsia and periuria. An ovarian granulosa cell tumour was identified and the cat underwent therapeutic ovariohysterectomy (OHE). The cat's clinical signs resolved, but 6 months later it was diagnosed as having an anaplastic astrocytoma and was euthanased. Serum anti-Müllerian hormone (AMH) concentration prior to OHE was increased vs a control group of entire and neutered female cats. Following OHE, serum AMH concentration decreased to <1% of the original value.RELEVANCE AND NOVEL INFORMATION:Serum AMH measurement may represent a novel diagnostic and monitoring tool for functional ovarian neoplasms in cats.

OBJECTIVES:To report the short- and long-term outcomes of one- or two-staged suture attenuation for complete closure of intrahepatic congenital portosystemic shunts in dogs.MATERIALS AND METHODS:Retrospective cohort study of dogs surgically treated for intrahepatic congenital portosystemic shunts between February 2000 and March 2015. Long-term follow-up was conducted by telephone conversations with the referring veterinary surgeon, owner, or both.RESULTS:In total, 55 dogs had suture attenuation of their intrahepatic congenital portosystemic shunt; 10 dogs (18·2%) tolerated complete attenuation, whilst 45 dogs (81·8%) tolerated partial attenuation. Postoperative complications occurred in 24 dogs (43·6%), and six dogs (10·9%) died. Repeat surgery was performed in 33 of 39 dogs (84·6%) that had previously undergone partial attenuation, and 27 of these (84·9%) ultimately achieved complete shunt attenuation. One dog (3·0%) died following second surgery, resulting in an overall postoperative mortality of seven of 55 (12·7%). Detailed follow-up was available for 22 dogs that were still alive at a median of 29 months after surgery (7·4 to 103·1) with a subjectively good quality of life. Of 17 dogs (82·4%), 14 with complete attenuation in one or two surgeries had an excellent outcome compared with one of five dogs (20%) with persistent shunting.CLINICAL SIGNIFICANCE:Staged suture ligation resulted in a high proportion of complete attenuation and reduced persistent shunting compared with a single surgery. Repeat surgery was associated with fewer complications than the first surgery. The proportion of dogs with an excellent outcome was greater for those that had complete attenuation in one or two surgeries compared with those with persistent shunting.

CASE SUMMARY:A cat with a chronic diaphragmatic rupture presented with neurological signs, including twitching and focal seizures. Blood ammonia level was markedly elevated and therefore neurological signs were thought to be related to hepatic encephalopathy. Exploratory laparotomy revealed that the left lateral and medial liver lobes were herniated into the thorax and multiple acquired portosystemic shunts (MAPSS) were present. The hernia was reduced and the diaphragm repaired. Neurological signs gradually resolved following surgery and 1 year postoperatively the cat was clinically normal, was not on any medication and had no evidence of hepatic dysfunction.RELEVANCE AND NOVEL INFORMATION:This is the first report of a chronic diaphragmatic rupture leading to MAPSS in a cat.

Surgical attenuation of a congenital portosystemic shunt (CPSS) results in increased portal vein perfusion, liver growth and clinical improvement. Portal lipopolysaccharide (LPS) is implicated in liver regeneration via toll-like receptor (TLR) 4 mediated cytokine activation. The aim of this study was to investigate factors associated with LPS in dogs with CPSS. Plasma LPS concentrations were measured in the peripheral and portal blood using a limulus amoebocyte lysate (LAL) assay. LPS concentration was significantly greater in the portal blood compared to peripheral blood in dogs with CPSS (P = 0.046) and control dogs (P = 0.002). LPS concentrations in the peripheral (P = 0.012) and portal (P = 0.005) blood of dogs with CPSS were significantly greater than those of control dogs. The relative mRNA expression of cytokines and TLRs was measured in liver biopsies from dogs with CPSS using quantitative PCR. TLR4 expression significantly increased following partial CPSS attenuation (P = 0.020). TLR4 expression was significantly greater in dogs that tolerated complete CPSS attenuation (P = 0.011) and those with good portal blood flow on pre-attenuation (P = 0.004) and post-attenuation (P = 0.015) portovenography. Serum interleukin (IL)-6 concentration was measured using a canine specific ELISA and significantly increased 24 h following CPSS attenuation (P < 0.001). Portal LPS was increased in dogs with CPSS, consistent with decreased hepatic clearance. TLR4 mRNA expression was significantly associated with portal blood flow and increased following surgery. These findings support the concept that portal LPS delivery is important in the hepatic response to surgical attenuation. Serum IL-6 significantly increased following surgery, consistent with LPS stimulation via TLR4, although this increase might be non-specific.

Hepatic encephalopathy (HE) is an important cause of morbidity and mortality in patients with liver disease. The pathogenesis of he is incompletely understood although ammonia and inflammatory cytokines have been implicated as key mediators. To facilitate further mechanistic understanding of the pathogenesis of HE, a large number of animal models have been developed which often involve the surgical creation of an anastomosis between the hepatic portal vein and the caudal vena cava. One of the most common congenital abnormalities in dogs is a congenital portosystemic shunt (cpss), which closely mimics these surgical experimental models of HE. Dogs with a cPSS often have clinical signs which mimic clinical signs observed in humans with HE. Our hypothesis is that the pathogenesis of HE in dogs with a cPSS is similar to humans with HE. The aim of the study was to measure a range of clinical, haematological and biochemical parameters, which have been linked to the development of HE in humans, in dogs with a cPSS and a known HE grade. One hundred and twenty dogs with a cPSS were included in the study and multiple regression analysis of clinical, haematological and biochemical variables revealed that plasma ammonia concentrations and systemic inflammatory response syndrome scores predicted the presence of HE. Our findings further support the notion that the pathogenesis of canine and human HE share many similarities and indicate that dogs with cPSS may be an informative spontaneous model of human HE. Further investigations on dogs with cPSS may allow studies on HE to be undertaken without creating surgical models of HE thereby allowing the number of large animals used in animal experimentation to be reduced.

Dogs with congenital portosystemic shunts (CPSS) have liver hypoplasia and hepatic insufficiency. Surgical CPSS attenuation results in liver growth associated with clinical improvement. The mechanism of this hepatic response is unknown, although liver regeneration is suspected. This study investigated whether markers of liver regeneration were associated with CPSS attenuation. Dogs treated with CPSS attenuation were prospectively recruited. Residual liver tissue was collected for gene expression analysis (seven genes) from 24 CPSS dogs that tolerated complete attenuation, 25 dogs that tolerated partial attenuation and seven control dogs. Relative gene expression was measured using quantitative polymerase chain reaction (qPCR). Blood samples were collected before, 24 h and 48 h post-surgery from 36 CPSS dogs and from 10 control dogs. Serum hepatocyte growth factor (HGF) concentration was measured using a canine specific enzyme-linked immunosorbent assay (ELISA). HGF mRNA expression was significantly decreased in CPSS compared with control dogs (P = 0.046). There were significant increases in HGF (P = 0.050) and methionine adenosyltransferase 2 A (MAT2A; P = 0.002) mRNA expression following partial CPSS attenuation. Dogs with complete attenuation had significantly greater MAT2A (P = 0.024) mRNA expression compared with dogs with partial attenuation. Serum HGF concentration significantly increased 24 h following CPSS attenuation (P < 0.001). Hepatic mRNA expression of two markers of hepatocyte proliferation (HGF and MAT2A) was associated with the response to surgery in dogs with CPSS, and serum HGF significantly increased following surgery, suggesting hepatocyte proliferation. These findings support the concept that hepatic regeneration is important in the hepatic response to CPSS surgery.