Vogel et al: Clinical presentation, treatment, and outcomes for 15 dogs with two or three congenital extrahepatic portosystemic shunts
Veterinary Surgery 5, 2026

🔍 Key Findings

Dogs with two or three congenital extrahepatic portosystemic shunts (M-EHPSS) had outcomes comparable to dogs with single EHPSS when all shunts were appropriately identified and attenuated.
Miniature Schnauzers comprised 47% (7/15) of cases, suggesting a potential breed predisposition to M-EHPSS.
The left gastrophrenic–left gastroazygos (LGP–LGA) combination was the most common shunt configuration (67%).
Left gastrophrenic shunts were consistently the shunts most commonly missed during initial CT interpretation, resulting in incomplete attenuation in five dogs.
Good or excellent long-term outcomes occurred in 86% (12/14) of treated dogs despite some dogs having incomplete attenuation.
Only one postoperative mortality occurred (7%), secondary to post-attenuation neurologic syndrome (PANS).
Dogs with missed shunts showed less improvement in bile acids than dogs with complete attenuation, emphasizing meticulous CT evaluation before surgery.
Clinical presentation and biochemical abnormalities closely resembled those of dogs with single congenital EHPSS rather than representing a more severe disease.

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Vogel et al: Clinical presentation, treatment, and outcomes for 15 dogs with two or three congenital extrahepatic portosystemic shunts
Veterinary Surgery 5, 2026

🔍 Key Findings

Dogs with two or three congenital extrahepatic portosystemic shunts (M-EHPSS) had outcomes comparable to dogs with single EHPSS when all shunts were appropriately identified and attenuated.
Miniature Schnauzers comprised 47% (7/15) of cases, suggesting a potential breed predisposition to M-EHPSS.
The left gastrophrenic–left gastroazygos (LGP–LGA) combination was the most common shunt configuration (67%).
Left gastrophrenic shunts were consistently the shunts most commonly missed during initial CT interpretation, resulting in incomplete attenuation in five dogs.
Good or excellent long-term outcomes occurred in 86% (12/14) of treated dogs despite some dogs having incomplete attenuation.
Only one postoperative mortality occurred (7%), secondary to post-attenuation neurologic syndrome (PANS).
Dogs with missed shunts showed less improvement in bile acids than dogs with complete attenuation, emphasizing meticulous CT evaluation before surgery.
Clinical presentation and biochemical abnormalities closely resembled those of dogs with single congenital EHPSS rather than representing a more severe disease.

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Multiple Choice Questions on this study

In Vogel 2026 et al., on multiple EHPSS, which shunt configuration was identified most frequently?

A. Left gastrophrenic–left gastroazygos

B. Left gastric–phrenicoabdominal

C. Spleno-gonadal–spleno-iliac

D. Left colic–left iliac

E. Right gastrophrenic

Answer: Left gastrophrenic–left gastroazygos

Explanation: The LGP-LGA configuration occurred in 10 of 15 dogs (67%), making it the predominant anatomy.

In Vogel 2026 et al., on multiple EHPSS, what proportion of surgically treated dogs achieved a good or excellent long-term clinical outcome?

A. 57% (8/14)

B. 64% (9/14)

C. 71% (10/14)

D. 86% (12/14)

E. 93% (13/14)

Answer: 86% (12/14)

Explanation: Twelve of 14 surgically treated dogs had good or excellent outcomes, indicating that M-EHPSS carries a prognosis comparable to single congenital EHPSS when appropriately managed.

In Vogel 2026 et al., on multiple EHPSS, which shunt was most commonly overlooked during initial CT evaluation?

A. Left gastric-azygos

B. Left gastrophrenic

C. Right gastrophrenic

D. Left colic-left iliac

E. Spleno-gonadal

Answer: Left gastrophrenic

Explanation: All retrospectively missed vessels were left gastrophrenic shunts, emphasizing careful CT review before surgery.

In Vogel 2026 et al., on multiple EHPSS, what was the principal clinical implication of retrospectively missed left gastrophrenic shunts?

A. They significantly increased postoperative mortality.

B. They prevented surgical attenuation of any shunt.

C. They resulted in less postoperative improvement in serum bile acids despite generally favorable clinical outcomes.

D. They invariably progressed to multiple acquired portosystemic shunts (MAPSS).

E. They caused severe portal hypertension in every affected dog.

Answer: They resulted in less postoperative improvement in serum bile acids despite generally favorable clinical outcomes.

Explanation: Dogs with missed left gastrophrenic shunts showed smaller reductions in bile acid concentrations than dogs with complete attenuation, although most still had good or excellent clinical outcomes.

In Vogel 2026 et al., on multiple EHPSS, which breed represented nearly half of all dogs diagnosed with multiple congenital extrahepatic portosystemic shunts?

A. Yorkshire Terrier

B. Miniature Schnauzer

C. Jack Russell Terrier

D. Toy Poodle

E. Bichon Frise

Answer: Miniature Schnauzer

Explanation: Miniature Schnauzers accounted for 47% (7/15) of cases, suggesting a possible breed predisposition.

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