Assistant Professor, Small Animal Surgery University of Georgia Athens, Georgia
Outcome of Medical Versus Surgical Management of a Congenital Extrahepatic Portosystemic Shunts in Older Dogs: A Multi-Institutional Retrospective Study. Wallace ML1, Grimes JA1, Edwards L2, Lux C2, Tam C3, Dickerson V3, Carroll KA4, Scharf VF4, Colberg V5, Kudej RK5, Otomo A6, Singh A6, Miller A7, Regier PJ7, Curcillo C8, Holt DE8, Ogden J9, Arai S10, Upchurch D11, Eicher L12, Howard J12, Hardie R13, Zellner E14, Milovancev M15, Heape N16, Bennett B16, Matz B16, Schmiedt CW1. 1University of Georgia, Athens, GA; 2University of Tennessee, Knoxville, TN; 3Texas A&M University, College Station, TX; 4North Carolina State University, Raleigh, NC; 5Tufts University, North Grafton, MA; 6University of Guelph, Ontario Veterinary College, Guelph, ON, Canada; 7University of Florida, Gainesville, FL; 8University of Pennsylvania, Philadelphia, PA; 9Purdue University, West Lafayette, IN; 10University of Minnesota, Minneapolis, MN; 11Kansas State University, Manhattan, KS; 12The Ohio State University, Columbus, OH; 13University of Wisconsin-Madison, Madison, WI; 14Iowa State University, Ames, IA; 15Oregon State University, Corvallis, OR; 16Auburn University, Auburn, AL.
While most dogs are diagnosed with congenital extrahepatic portosystemic shunts (EHPSS) early in life, there remains a population of dogs diagnosed later either incidentally or due to the delayed development of clinical signs. The objective of this study was to determine the outcome in dogs diagnosed with EHPSS at ≥ 5 years of age treated with medical management only (M) or with surgical attenuation (S). The hypothesis was that dogs undergoing surgical EHPSS attenuation would have a longer survival time than dogs undergoing medical management only. Medical records of dogs definitively diagnosed with EHPSS at five years of age or older presented to 16 veterinary teaching hospitals between January 2009 and June 2019 were evaluated. Data collected included signalment, clinical signs at diagnosis, clinical pathological data, surgical and medical treatments, shunt morphology, and clinical signs and medical therapies at 6–12 months post diagnosis. Three hundred fifty-one dogs (119 (33.9%) M, 232 (66.1%) S) were included in the study. Survival was longer with surgery than medical management (P < 0.001, HR 4.2, 10.9 years S, 3.4 years M). Continued clinical signs at 6–12 months after diagnosis were more common with medical management (P < 0.001, 40% (33/88) M, 14% (21/155)). Continued medical therapies at 6–12 months after diagnosis were more common with medical management (P < 0.001, 78% (69/88) M, 34% (53/155) S). Dogs diagnosed at ≥ 5 years of age with EHPSS have significantly better survival times and improved quality of life with surgical attenuation as compared to medical management.