Diagnostic value of blood variables following attenuation of congenital extrahepatic portosystemic shunt in dogs

BackgroundThe aims of this study were to determine if extrahepatic portosystemic shunt (EHPSS) postoperative closure could be predicted based on preoperative blood analyses and to determine the accuracy of blood variables to evaluate persistence of portosystemic shunting postoperatively (multiple ac...

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Bibliographic Details
Published in:	Veterinary record Vol. 187; no. 7; p. e48
Main Authors:	Vallarino, Nicolas, Pil, Steven, Devriendt, Nausikaa, Or, Matan, Vandermeulen, Eva, Serrano, Gonçalo, Paepe, Dominique, Bosmans, Tim, de Rooster, Hilde
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group Limited 03-10-2020 Blackwell Publishing Ltd
Subjects:	ammonia Animals Blood canine Dog Diseases - blood Dog Diseases - diagnosis Dog Diseases - surgery Dogs Female Hypertension Laboratories Liver Male Medical imaging Medical records multiple acquired shunts Portal System - abnormalities Portal System - surgery Portasystemic Shunt, Surgical - veterinary portosystemic shunt Retrospective Studies Scintigraphy Sensitivity and Specificity serum bile acids Statistical analysis Surgery Surgical outcomes Treatment Outcome Ultrasonic imaging Veterinary medicine ammonia portosystemic shunt canine serum bile acids multiple acquired shunts
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Summary:	BackgroundThe aims of this study were to determine if extrahepatic portosystemic shunt (EHPSS) postoperative closure could be predicted based on preoperative blood analyses and to determine the accuracy of blood variables to evaluate persistence of portosystemic shunting postoperatively (multiple acquired portosystemic shunts (MAPSS) or persistent EHPSS).MethodsRetrospectively, 62 dogs treated surgically for congenital EHPSS that underwent postoperative trans-splenic portal scintigraphy or CT angiography three to six months postoperatively were included.ResultsNone of the studied preoperative blood variables could unambiguously predict surgical outcome. Elevated postoperative fasting venous ammonia (FA) concentration always indicated surgical failure (persistent shunting or MAPSS), but normal FA did not provide any information on the postoperative shunting status. Paired serum bile acids (SBA) were not reliable enough to confirm or exclude postoperative shunting. In the presence of low normal postoperative FA levels, elevated preprandial SBA was more likely in dogs with persistent shunting (sensitivity of 0.79, specificity of 0.83), whereas postprandial SBA below reference limit was more often observed in case of surgical success (sensitivity of 0.93, specificity of 0.67).ConclusionBlood variables, and more specifically the combination of FA and SBA, are not a valuable alternative to advanced medical imaging to reliably assess the surgical outcome after EHPSS surgery.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0042-4900 2042-7670
DOI:	10.1136/vr.105296