Hepatic shunts represent an abnormal direct connection between the portal vein (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 Portosystemic 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 surgical methods and the minimally invasive Stent&Coil technique are described. All methods have in common that they don’t close the shunt itself, but the hepatic vein which drains the shunt. Closing the draining vein instead of the shunt itself can lead to new collateral shunts which can lead to relapse of the problems associated with the shunt in the longterm.
Prof. Matthias Schneider at the University of Giessen developed a novel minimally invasive method for direct closure of intraheptic shunts (Direct Shunt Embolisation). This novel method allows closure of the shunt connection itself which is a crucial point for a successfull longterm outcome. Further it achieves a gradual controlled closure of the vessel. This enables treatment of patients with very poorly developed portal vessels which represent the majority of patients with intrahepatic shunts. SCVS is bringing this novel technique to the UK in collaboration with Prof. Matthias Schneider.
