Endovascular Treatment

Intrahepatic portosystemic shunts
single, extrahepatic PSSs are amenable to relatively uncomplicated surgical attenuation, however surgical repair of intrahepatic PSSs are consistently more challenging. Numerous techniques have been described for intrahepatic PSS attenuation, however morbidity and mortality rates can be very high, even for the most experienced surgeons. The goal of IR techniques for IHPSSs is to reduce the unacceptably high, peri-operative mortality rates associated with traditional open surgical techniques and hopefully improve the outcome for these cases. The author has performed over 100 percutaneous transvenous coil embolizations (PTCE) with a vena caval stent and thrombogenic coils placed within the shunt. Peri-operative complications were mostly minor and peri- operative mortalities were comparatively low versus that reported for traditional surgery.

Procedure
Percutaneous Transvenous Coil Embolization: All dogs were treated medically initially following diagnosis of the IHPSS for a period of weeks to months. When possible, CT or MR angiography was performed to delineate the shunt anatomy and obtain caval and shunt measurements under a separate anesthetic episode. All PTCE procedures were performed under general anesthesia using standard liver dysfunction protocols and often neuromuscular blockade to minimize respiratory artifact during digital subtraction angiography. Peri-operative cefoxitin was administered at 30mg/kg once, followed by 20mg/kg q2 hours during the procedure. Some variation in procedure occurred over the years performing these cases but the basic procedure is described below with slight variation of that originally described by Schneider et al.  [...]