Olive is an 8-month-old Golden Retriever who started showing vague signs of low appetite and lethargy at 4 months. Her clinical signs progressed, and she became disoriented and ataxic. She was rushed to the ER and after an extensive workup, she was diagnosed with an intrahepatic portosystemic shunt, which is a congenital disease of the portal vein. The portal vein is a large vein that collects blood from the digestive tract and other organs and brings it into the liver, where toxins and other byproducts are removed. A liver shunt occurs when there is an abnormal connection between the portal vein and another vein, allowing blood to bypass around the liver. The toxins in the blood are then circulated around the body and cause clinical signs like Olive’s. Dr. Kyle Martin determined the best treatment option for Olive was a minimally invasive procedure, known as Percutaneous Transvenous Coil Embolization (PTCE). With this procedure, abnormal clinical signs caused by portosystemic shunt are eliminated in 90% of cases.
First, an incision is made over the right jugular vein and a guidewire is passed into the vein. With the aid of fluoroscopy and the guidewire, a special catheter is passed through the jugular vein into the caudal vena cava until reaching the site of the shunt. Next, a stent is deployed into the vena cava at the site where the shunt enters the vena cava. The stent is placed as a barrier to keep clot-forming coils in place and does not affect the blood flow in the vena cava. Lastly, with the help of the guidewire, multiple clot-forming coils are placed into the shunt to partially obstruct the blood flow through the shunt site. Over time, blood clots will form around the coils and slowly obstruct the shunt, subsequently correcting the disease. Traditionally, the surgical treatment options for intrahepatic portosystemic shunts involve opening the abdomen and ligating of the abnormal vein, which can put patients at risk for serious complications like bleeding. With this minimally invasive procedure, we were able to treat Olive through one small incision over her jugular vein rather than a large incision through the abdomen.
Olive recovered well from surgery and anesthesia and was discharged after a brief hospital stay. Olive was back to running around within a week after her procedure. The owners are thrilled to report that she is now eating and playing like a normal puppy!