ameroid constrictor vs coil embolization for pss

#AMEROID CONSTRICTOR VS COIL EMBOLIZATION FOR PSS SERIES#

The phrenic catheter was removed and a 12 × 60 mm self-expanding vascular stent (Zilver vascular self-expanding stent ) was positioned in the hepatic caudal vena cava across the insertion of the phrenic vein into the caudal vena cava, ensuring that 2–3 cm of length existed on either side of the phrenic vein ostium ( Figure 1). The presence of the shunt was confirmed, and portal pressure as measured through the shunting portal vein was measured to be 11 mmHg. The marker catheter was removed and a 4 F Berenstein catheter (Infiniti Medical) was positioned into the portosystemic shunt via the left phrenic vein, and a subtraction angiogram was performed similar to the previous venogram. The catheter was then connected to a calibrated pressure transducer and a central venous pressure of 11 mmHg was documented.

#AMEROID CONSTRICTOR VS COIL EMBOLIZATION FOR PSS SERIES#

An opacified image from this series was saved for calibration. A 5 F marker catheter (Infiniti Medical) was then positioned in the prehepatic vena cava and a bolus of a 4 ml 1:1 solution of iohexol (Omnipaque 300 mg I/ml GE Healthcare) and 0.9% sterile saline solution was administered under subtraction angiography to create a venogram. An 18 G catheter was placed in the right external jugular vein to facilitate placement of a 4 F micro-introducer, which was then replaced by a 6 F introducer sheath. The cat was positioned in dorsal recumbency and the cervical region aseptically prepared. The owner elected for PTCE and the procedure was planned for the following day. The owner was also informed that PTCE has recently been reported in four cats with intrahepatic portosystemic shunts with promising results. The owner was informed that open surgery is associated with a good prognosis in general, although neurologic complications can occur in up to 30% of cases and can lead to death. Treatment options were discussed, including open surgery for the placement of a slow occlusion device (eg, cellophane band) or percutaneous transvenous coil embolization (PTCE). CT revealed a single congenital extrahepatic, left gastrophrenic shunt measuring 7 mm in diameter with a diminutive main portal vein. A triple-phase CT angiogram (160-slice ) was performed to reassess the shunt and measure for procedural planning. It was still receiving the medications previously prescribed by the specialty hospital, and the clinical signs had reportedly resolved with medical management. The cat was started on levetiracetam (20 mg/kg PO q8h), lactulose (1 ml PO q8h), metronidazole (8 mg/kg PO q12h) and famotidine (1 mg/kg PO q24h).Īt 10 months of age, the cat was referred to the minimally invasive surgery service at the University of Florida. The tentative diagnosis was a single congenital left divisional intrahepatic portosystemic shunt. The specialty hospital performed contrast CT of the abdomen, given the suspicion of a portosystemic shunt. The cat was seen by a private specialty hospital that performed serum bile acids testing, which revealed markedly elevated pre- (130 µmol/l RI 0–5) and postprandial (180 µmol/l no RI) serum bile acids. The clinical signs improved significantly while on the medications but returned soon after discontinuation. The cat was vaccinated against rabies and was prescribed clindamycin (5 mg/kg PO q12h for 14 days) and prednisone (1 mg/kg PO q24h with gradual taper over 2 weeks). Given the reported neurologic signs and lack of vaccination history, the possibility of infectious disease was considered.

Thoracic and abdominal radiographs were reported to have no significant abnormalities. A complete blood count was unremarkable, and serum biochemistry revealed a low blood urea nitrogen (BUN) (11 mg/dl reference interval 16–33) and hyperglycemia (185 mg/dl RI 77–153). Physical examination revealed normal vital parameters, a body weight of 2.9 kg and mild dehydration but no other physical abnormalities.

It was noted to be aggressive, with marked ptyalism. The cat was initially presented to the referring veterinarian for examination and vaccinations. The owner also reported intermittent bouts of aggression, hissing and suspected blindness. At the time, the cat was lethargic and salivating excessively. A 5-month-old male domestic shorthair cat was initially found and adopted as a stray.

Ameroid constrictor vs coil embolization for pss