There is nothing minimal about Matilda, the 88-pound, one-year-old Scottish Deerhound recently treated at the Matthew J. Ryan Veterinary Hospital. But when an abnormal blood vessel was discovered in Matilda’s liver, a minimally invasive procedure was the key to improving her liver function.

Matilda’s Condition

Matilda’s breeder routinely checks her puppies’ blood work for evidence of a liver shunt, which can be inherited in Scottish Deerhounds and lead to liver failure and a lethal buildup of toxins if left untreated. When Matilda’s results appeared to be questionable, she was taken to Penn Vet to see Dr. Dana Clarke. An ultrasound and subsequent CT scan confirmed that Matilda did indeed have an intrahepatic liver shunt.

In a healthy dog, food is broken down in the intestines, absorbed into the blood stream, and taken via the portal vein to the liver. From there, the blood branches into the liver tissue for detoxification. Then it collects into the hepatic veins, enters the vena cava, and goes back to the heart.

“The liver receives more than 85 percent of its blood supply from the portal vein,” says Dr. Clarke. “So that vein plays a major role in providing the nutrition and oxygen that the liver needs. In Matilda’s case, the presence of a shunt compromised blood flow to her liver, causing it to be small in size with poor functionality.”

Unlike extrahepatic shunts (found outside of the liver), intrahepatic shunts – typically found in large dogs – are difficult to fix surgically. In order to reach the abnormal blood vessel, a surgeon must dissect through the liver tissue, making for a risky surgery with high morbidity and mortality rates.

Rather than pursue open surgery, Dr. Clarke brought Matilda to Penn Vet’s state-of-the-art Buerger Family Foundation Minimally Invasive Surgery Suite. Continuing Penn Vet’s rich history of “firsts,” the Minimally Invasive Surgery Suite is the first of its kind in a veterinary teaching hospital and one of the only operating rooms in veterinary medicine offering a comprehensive array of minimally invasive surgical procedures for companion animals.

A Minimally Invasive Procedure

After making a mere one-centimeter incision over Matilda’s jugular vein, Dr. Clarke used interventional radiology techniques under fluoroscopic guidance in order to insert a catheter into the shunt.

After determining the blood pressure in the shunt and understanding how it joined the vena cava, Dr. Clarke put a stent made of titanium and nickel inside the vena cava to act as a cage. She then delivered thrombogenic coils into the shunt, which are held in place by the stent. Small cotton-like fibers on the coils induce a blood clot to form, redirecting the flow of blood through Matilda’s liver instead of through the shunt. On average, six to eight coils are used to induce a clot. Due to the size of Matilda’s shunt, 12 coils were required to decrease blood flow through the shunt.

Within three hours of surgery, Matilda was eating. Because of the minimally invasive nature of her procedure, she did not require pain medications and there were no sutures or incisions that required careful monitoring. Matilda will have blood work checked in the next month to know how successful the procedure was at improving her liver function. It is possible she could need additional coils in the future, which are also placed in a minimally invasive fashion.

“We are incredibly grateful to Dr. Clarke and the team at Penn Vet,” said Shelly Wyatt, DVM, owner of Matilda. “The minimally invasive surgery not only saved Matilda’s life, but it also allowed her to get back on her feet in a remarkably short amount of time.”

Despite Matilda’s large stature, all it took was a one-centimeter incision to perform the groundbreaking procedure that will ensure this loveable pup continues to grow and thrive in the future.

To view a stent-cava procedure, download the animation at Infiniti Medical.