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Garcia et al: Use of intraoperative transsplenic injection of agitated saline to confirm temporary full attenuation of congenital extrahepatic portosystemic shunts in dogs
Veterinary Surgery 2, 2025

🔍 Key Findings

  • 40 dogs with congenital EHPSS were surgically treated using intraoperative transsplenic injection of agitated saline (TIAS) to assess full temporary occlusion.
  • TIAS was successful in 38/40 dogs; the remaining 2 had additional shunting vessels not originally seen and required further identification/ligation.
  • No intraoperative or postoperative complications occurred.
  • TIAS allowed real-time confirmation of attenuation success using ultrasound-visible microbubbles.
  • Median postoperative bile acids were 5 μmol/L (preprandial) and 25 μmol/L (postprandial).
  • Long-term outcomes: 29/39 dogs had excellent, 10/39 had good outcomes; 3 dogs died unrelated to EHPSS.
  • Technique is presented as a safe, quick, low-cost, accessible intraoperative assessment alternative to IOMP or SP.

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← Articles

Garcia et al: Use of intraoperative transsplenic injection of agitated saline to confirm temporary full attenuation of congenital extrahepatic portosystemic shunts in dogs
Veterinary Surgery 2, 2025

🔍 Key Findings

  • 40 dogs with congenital EHPSS were surgically treated using intraoperative transsplenic injection of agitated saline (TIAS) to assess full temporary occlusion.
  • TIAS was successful in 38/40 dogs; the remaining 2 had additional shunting vessels not originally seen and required further identification/ligation.
  • No intraoperative or postoperative complications occurred.
  • TIAS allowed real-time confirmation of attenuation success using ultrasound-visible microbubbles.
  • Median postoperative bile acids were 5 μmol/L (preprandial) and 25 μmol/L (postprandial).
  • Long-term outcomes: 29/39 dogs had excellent, 10/39 had good outcomes; 3 dogs died unrelated to EHPSS.
  • Technique is presented as a safe, quick, low-cost, accessible intraoperative assessment alternative to IOMP or SP.

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Multiple Choice Questions on this study

In García 2025 et al., on TIAS shunt confirmation, which imaging method was NOT required during the procedure?

A. Ultrasound
B. Fluoroscopy
C. Abdominal CT
D. CTA
E. All of the above

Answer: Fluoroscopy

Explanation: TIAS used only ultrasound; fluoroscopy and CTA were not needed for intraoperative guidance.
In García 2025 et al., on TIAS shunt confirmation, what best describes the overall safety of the technique?

A. Significant bleeding in >10% of dogs
B. Postop seizures common
C. Intraoperative mortality occurred
D. Minor splenic bleeding easily controlled
E. High rate of infection from splenic injection

Answer: Minor splenic bleeding easily controlled

Explanation: TIAS was safe with only mild bleeding at the injection site in all dogs, which resolved quickly.
In García 2025 et al., on TIAS shunt confirmation, what was the long-term clinical outcome in most dogs?

A. Good outcome with recurrence
B. Excellent outcome with no medication
C. Poor outcome with seizures
D. Required second surgery
E. Died from shunt-related causes

Answer: Excellent outcome with no medication

Explanation: 29/39 dogs had excellent long-term outcome, requiring no medications or diet changes.
In García 2025 et al., on TIAS shunt confirmation, what was the outcome in dogs with microbubbles still visible after initial occlusion?

A. Confirmed complete attenuation
B. Required ligation of second vessel
C. Required coil embolization
D. Underwent thoracotomy
E. Exhibited portal hypertension

Answer: Required ligation of second vessel

Explanation: Two dogs had microbubbles after occlusion due to secondary vessels and required additional ligation.
In García 2025 et al., on TIAS shunt confirmation, what confirmed complete shunt occlusion?

A. Microbubble entry into left atrium
B. Elevated portal pressure
C. No microbubbles seen in right atrium
D. Delayed saline transit through liver
E. Absence of contrast on CTA

Answer: No microbubbles seen in right atrium

Explanation: Microbubbles appear in the right atrium when EHPSS is patent. Their absence after temporary occlusion confirms full attenuation.

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