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.

Minimally invasive techniques have been described for the treatment of intrahepatic portosystemic shunts. The commonly offered ‘stent and coil’ technique does not close the shunt itself, it embolises the vein draining the shunt. Often complete closure is not possible with this technique and it carries the risk of new shunt connections forming. Many patients may therefore still need to stay on medical management following ‘stent and coil’ intervention. Long-term closure is, however, key for successful management of patients with intrahepatic shunts. For more detailed explanations, read more about intrahepatic shunts.

Prof. Matthias Schneider at the University of Giessen, Germany has developed an innovative method which allows complete closure of the intrahepatic shunt in the majority of patients – even in those with only very little portal vessels. The combination of direct shunt embolization with an antithrombotic protocol protracting closure over several months makes this possible. The method is technically difficult and requires a lot of interventional experience. The Cardiology Team at SCVS headed by Tobi Wagner has that expertise and we are very proud that we were able setting up a cooperation with Matthias Schneider who is professor at the University of Giessen, Germany for training our team at SCVS to establish this technique at SCVS and in the UK.

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