34th Annual Scientific Meeting proceedings

Objectives:

Congenital extrahepatic portosystemic shunts (CEPSS) frequently occur in small breed dogs, approximately 25% of CEPSS cases terminate on the azygos vein within the thoracic cavity, known as portoazygos (PA) shunts. They are conventionally attenuated intra-abdominally. The aim of this study is to evaluate the PA shunt attenuation by cellophane band using thoracoscopic approach in three dogs.

Methods:

Dogs were placed in sternal recumbency. Ports were established in the right caudal thorax, the port for the optics was introduced in the middle of the 10th intercostal space, two other cannulas were introduced in the dorsal third of the 9th and 11th intercostal spaces respectively. Thoracoscopic exploration allowed to identify the PA shunt close to the azygos vein. The aberrant vessel was dissected and isolated for at least 2 cm. A 4-mm-wide triple-layer cellophane band previously prepared was placed around the vessel using a right-angled forceps. Four clips were applied in an alternating manner from both sides of the cellophane aiming to achieve the shunt correct attenuation.

Results:

A 6-month 3 kg poodle, an 8-month 3,5 kg Yorkshire, and a 12-month 5kg cross breed affected by PA shunts were included. Median surgical time was 30 minutes (range 27-33). No major or minor complications were observed during the surgical procedure. Five months after surgery, a CT scan was performed, and the correct shunt attenuation was confirmed.

Conclusions:

Thoracoscopy offers a direct path to the terminal PA shunt with minimal soft tissue dissection. Cellophane band application to the PA shunt using a thoracoscopic approach appears to be feasible.