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UC Davis Veterinarians Use Innovative Surgical Technique to Save Puppy with Liver Defect

January 9, 2015

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UC Davis veterinary surgeons used Interventional Radiology to fix Sandy’s liver defect.

VMTH "Case of the Month" – January 2015
 


Sandy, a 6-month-old female Labrador retriever, presented to UC Davis Veterinary Medical Teaching Hospital for evaluation and treatment of an intrahepatic portosystemic shunt (IHPSS). An IHPSS is a birth defect of the blood vessels that bring blood to the liver for purification.

Sandy was previously diagnosed with the IHPSS by her referring veterinarian, and Sandy’s vet suggested her owners bring her to UC Davis to see Dr. Bill Culp with the Soft Tissue Surgery Service. Sandy’s family made the 500 mile journey from their home near San Diego to see Dr. Culp, who has performed many shunt procedures.

Dr. Culp’s team got to work on Sandy, performing several diagnostics as part of their study on Sandy’s IHPSS, including a technetium scan, bloodwork, a CT scan and an abdominal ultrasound. All tests confirmed or were consistent with the presence of an IHPSS. The CT scan allowed visualization of the shunting vessel and helped with planning the best treatment approach. The goal of any treatment with liver shunts is to close the shunting vessel over time, thus redirecting blood flow through the liver, allowing adequate nutrition to reach the liver, as well as for toxins to be removed from the systemic circulation.

Historically, the treatment options for IHPSS included medical management or an open surgery. The outcomes with these treatments were variable, and many dogs would not respond well. A newer Interventional Radiology technique, called percutaneous transvenous coil embolization (PTCE), performed in a minimally invasive fashion has recently shown promise in the treatment of this disease. UC Davis is one of the few veterinary hospitals offering this state-of-the-art therapy and is one of the leaders in Interventional Radiology. Dr. Culp and his team discussed the situation with Sandy’s owner, and it was decided that treating the shunt with PTCE was the best course of action.

Sandy was anesthetized and prepared for her procedure, and the PTCE was performed. During the PTCE procedure, a stent is placed through peripheral veins into the caudal vena cava (largest vein in the abdomen which returns deoxygenated blood to the heart) along the region of the shunt and coils are released into the shunt. These coils allow for clot formation which will gradually occlude the shunt vessel over time.

Sandy’s surgery was a success. She returned home, where she was put on strict orders to rest for two weeks. That included only going outside on a leash, no running, no jumping and no playing – a tall order for a 6-month-old puppy. Sandy’s family made sure she got her proper rest, as this improved Sandy’s chances of a successful outcome.

Sandy returned to the VMTH three months after her surgery, and passed her re-check examination with flying colors. Her owners reported she was doing well at home with good activity levels and a good appetite. Her bloodwork showed improved liver values. A CT scan showed an improvement in liver size and vascularity demonstrating improved blood flow. Sandy’s initial response is very promising, and a full recovery is expected allowing Sandy to live a normal life.
 



About the Veterinary Medical Teaching Hospital
The William R. Pritchard Veterinary Medical Teaching Hospital at the University of California, Davis—a unit of the School of Veterinary Medicine—provides state-of-the-art clinical care while serving as the primary clinical teaching experience for DVM students and post graduate veterinarian residents. The VMTH treats more than 47,000 animals a year, ranging from cats and dogs to horses, cows and exotic species. To learn more about the VMTH, please go to www.vetmed.ucdavis.edu/vmth. Timely news updates can be received on its Facebook (www.facebook.com/ucdavisvetmed) and Twitter (www.twitter.com/ucdavisvetmed) pages.

Rob Warren
VMTH Communications & Marketing Officer
rjwarren@ucdavis.edu
530-752-2363