Journal of Small Animal Practice • Vol 59 • April 2018 • © 2017 British Small Animal Veterinary Association
Journal of Small Animal Practice (2018) 59, 201–210
Accepted: 6 October 2017; Published online: 22 November 2017
Intrahepatic congenital portosystemic
shunts in dogs: short- and long-term
outcome of suture attenuation
M. S. T *
, V. J. L * , P. B * D. J. B *
*Department of Clinical Sciences and Services , Royal Veterinary College , Hatfield , Hertfordshire , AL9 7TA , UK
Bristol Veterinary School , University of Bristol , Langford , Bristol , BS40 5DU , UK
Corresponding author: firstname.lastname@example.org
: To report the short- and long-term outcomes of one- or two-staged suture attenuation for
complete closure of intrahepatic congenital portosystemic shunts in dogs.
: Retrospective cohort study of dogs surgically treated for intrahepatic congenital
portosystemic shunts between February 2000 and March 2015. Long-term follow-up was conducted by
telephone conversations with the referring veterinary surgeon, owner, or both.
: In total, 55 dogs had suture attenuation of their intrahepatic congenital portosystemic shunt;
10 dogs (18·2%) tolerated complete attenuation, whilst 45 dogs (81·8%) tolerated partial attenuation.
Postoperative complications occurred in 24 dogs (43·6%), and six dogs (10·9%) died. Repeat surgery
was performed in 33 of 39 dogs (84·6%) that had previously undergone partial attenuation, and 27 of
these (84·9%) ultimately achieved complete shunt attenuation. One dog (3·0%) died following second
surgery, resulting in an overall postoperative mortality of seven of 55 (12·7%). Detailed follow-up was
available for 22 dogs that were still alive at a median of 29 months after surgery (7·4 to 103·1) with
a subjectively good quality of life. Of 17 dogs (82·4%), 14 with complete attenuation in one or two
surgeries had an excellent outcome compared with one of five dogs (20%) with persistent shunting.
: Staged suture ligation resulted in a high proportion of complete attenuation and
reduced persistent shunting compared with a single surgery. Repeat surgery was associated with fewer
complications than the first surgery. The proportion of dogs with an excellent outcome was greater
for those that had complete attenuation in one or two surgeries compared with those with persistent
Intrahepatic congenital portosystemic shunts (CPSS) are less
common in dogs than their extrahepatic counterparts, making
up approximately 25% to 33% of the total (Berent & Tobias
2009 , Berent & Tobias 2012 ). For both types of CPSS, surgical
attenuation is recommended to restore normal portal blood flow
and resolve clinical signs (Berent & Tobias 2009 , Tivers et al .
2012 , Greenhalgh et al . 2014 , Tivers et al . 2017 ). However, intra-
hepatic CPSS (IHCPSS) can be challenging to manage surgically
due to the location of the vessel within the liver parenchyma
(Hunt et al . 1996 , White et al . 1998 , Berent & Tobias 2009 ).
Surgical techniques for IHCPSS include suture ligation, ameroid
constrictors, cellophane banding and hydraulic occluders (White
et al . 1998 , Hunt et al . 2004 , Kummeling et al . 2004 , Adin et al .
2006 , Bright et al . 2006 , Mehl et al . 2007 ). Intravascular tech-
niques with hepatic inflow occlusion have been used to allow
attenuation of some IHCPSS, which is technically demanding