Page 17 - Eclipse - Autumn/Winter 2022

 

 

 

 

 

Page 17 - Eclipse - Autumn/Winter 2022
P. 17

CLINICAL NEWS


 CLINICAL NEWS  Surgery for rare vascular malformation

        of the Caudal Vena Cava




                                                                                Lorna’s owners decided to go ahead
                                                                                with surgery, and she returned for
                                                                                admission in early July. Surgery was
                                                                                performed by Dan Brockman, Professor
                                                                                of Small Animal Surgery and Director
                                                                                of the Cardiothoracic Surgery Service,
                                                                                supported by third-year surgery resident
                                                                                Carlos Alonso and third-year anaesthesia
                                                                                resident Nuria Quesada Vicent.
                                                                                Professor Brockman commented:
                                                                                “Because of the history of trauma and
                                                                                the high probability that Lorna had an
                                                                                acquired traumatic kink in her caudal
                year-old Rottweiler was treated   Lorna’s clinical presentation was   vena cava that was responsible for the
                for an acquired traumatic kink   comparable to dogs reported in   post-sinusoidal venous hypertension,
                in her caudal vena cava, which   veterinary literature describing kinking   we elected to explore the cava through
        A was responsible for post-         and tortuosity of the caudal vena cava.   a right sixth intercostal thoracotomy.
        sinusoidal venous hypertension. The   Documented dogs often presented in   At surgery, the scar tissue responsible
        trauma was most likely caused by an   young adulthood following blunt thoracic   for the ‘kink’ was obvious and
        altercation with a deer.            trauma. Lorna’s possible altercation with   incorporated the right phrenic nerve,
                                            a deer, coupled with evidence of rib
        Lorna was referred to the Emergency   fractures, mirrored those cases.   which was discontinuous.
        and Critical Care Service early last May                                “Having released the cava from the
        with ascites and suspected right-sided   Possible treatments included surgical   scar tissue, the caudal caval pressure
        cardiac failure. On presentation she   exploration and resection of the scar   remained slightly above cranial caval
        was alert and cardiovascularly stable.   tissue causing obstruction, resection of   pressure, so a patch of pericardium
        Ultrasound confirmed the presence   the narrow part of the caudal cava and   was sutured into a longitudinal incision
        of fluid in her abdomen. Radiographs   catheter-guided balloon dilation of the   across the stricture, made in the caudal
        revealed rib fractures.             lesion with stent placement. Nobody at   cava made inside a carefully positioned
                                            the  had performed treatment on
        An echocardiogram revealed an                                           Satinsky clamp. This reduced the caudal
        abnormal structure at the base of her   such a lesion but they suspected that   caval pressure such that it was just
        heart. A case conference involving   balloon dilation and/or stenting would   above mean cranial caval pressure.”
        cardiology and surgery was held and   be less appropriate as the kinking of   Lorna recovered uneventfully and was
        the conclusion was that the lesion was   the vena cava was likely associated   discharged on antiplatelet drugs for
        either a rare congenital or acquired   with fibrous tissue causing extra-luminal   a month, to reduce the risk of clots
        vascular malformation. CT confirmed a   compression and there would be a high   forming on the pericardial patch. She
        malformation of her caudal vena cava,   risk of recurrence. They also preferred   did well at home and, when returning for
        resulting in high pressure, which was   to avoid an intravascular implant in such   check-up, the team found no evidence
        the cause of her ascites. Her heart was   a young dog.                  of congestion of the abdominal aorta or
        found to be otherwise normal in structure.
                                                                                hepatic veins and no ascites.




















         CT angiogram reconstruction of kinked vena cava

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