Interventional direct intrahepatic shunt embolisation

Hepatic shunts represent an abnormal direct connection between the portal system (draining the intestinal tract) and the caudal vena cava. In the normal circumstance, the liver is positioned in-between these two vessels and 'cleans' the blood. In patients with hepatic shunts, blood from the gastrointestinal tract containing toxins and bacteria can directly enter the systemic circulation causing various problems. Many long-term complications arise in patients with untreated hepatic (portosystemic) shunts. Examples are ‘hepatic’ encephalopathy, GI bleeding, urinary tract stones, liver tumours, hepato-pulmonary syndrome, pulmonary hypertension, etc.

Most shunt vessels are positioned extrahepatic and the treatment of choice for these patients is surgical closure of the abnormal vessel. However, in some patients (especially large breed dogs) the shunt vessel can be positioned within the liver. This makes it very difficult to access and close.

Various minimally invasive techniques have been described for the treatment of intrahepatic portosystemic shunts, including ‘stent and coil’, and direct embolisation of the shunt vessel. Long-term closure is, however, key for successful management of patients with intrahepatic shunts. For more detailed explanations, read more about intrahepatic shunts.

Professor Matthias Schneider at the University of Giessen developed a novel minimally invasive method for closure of intrahepatic shunts. This novel method allows closure of the shunt vessel itself which is a crucial point for a successful long-term outcome. Further, it achieves a gradual controlled close of the vessel. This enables treatment of patients with very poorly developed portal vessels which represent the majority of patients with intrahepatic shunts.

Key facts

• Superior way of intrahepatic shunt closure
• Very good long-term outcome which is key
• SCVS is the only referral centre in the UK which offers this novel way.

Patients can be booked directly for the intervention if adequate diagnostics (AngioCT and blood tests) have been performed elsewhere.

Referring vets - Please contact SCVS on +44 (0)1425 485615 and ask to speak with Darren Kelly or Tobias Wagner if you have a patient which may be suitable.

Notes
Underlined – external/internal links

Coil in position following minimal invasive direct Shunt embolisationstyle