Changes

If the shunt cannot be ligated, attenuation may be achieved by three major techniques:

If the shunt cannot be ligated, attenuation may be achieved by three major techniques:

*An '''ameroid constrictor''' consists of a ring of stainless steel with an inner collar of casein.  When the ring is applied around a vessel, the casein sheath swells gradually to occlude blood flow and it may also stimulate some fibrosis.  Placement of an ameroid constrictor also results in a much shorter surgical time than complete ligation <ref>Hurn SD, Edwards GA. '''Perioperative outcomes after three different single extrahepatic portosystemic shunt attenuation techniques in dogs: partial ligation, complete ligation and ameroid constrictor placement.''' ''Aust Vet J. 2003 Nov;81(11):666-70.''</ref>.     

*An '''ameroid constrictor''' consists of a ring of stainless steel with an inner collar of casein.  When the ring is applied around a vessel, the casein sheath swells gradually to occlude blood flow and it may also stimulate some fibrosis.  Placement of an ameroid constrictor also results in a much shorter surgical time than complete ligation <ref>Hurn SD, Edwards GA. '''Perioperative outcomes after three different single extrahepatic portosystemic shunt attenuation techniques in dogs: partial ligation, complete ligation and ameroid constrictor placement.''' ''Aust Vet J. 2003 Nov;81(11):666-70.''</ref>.     

*'''Cellophane banding''' involves the application of cellophane around the shunt. This material is sutured in place to stimulate fibrosis around the vessel, resulting in gradual occlusion. Cellophane does not stimulate a strong inflammatory response in cats and should not be used in this species.

*'''Cellophane banding''' involves the application of cellophane around the shunt. Real cellophane is made from regenerated cellulose. <ref>Smith et al [http://www.ncbi.nlm.nih.gov/pubmed/23550728] </ref>evaluated commonly used sources of cellophane and determined that only one was cellulose based and not a plastic. This may be why historical outcomes of cellophane banding for attenuation of portosystemic shunts has been variable, especially in cats. Cellophane has reportedly variable outcomes in cats, and some surgeons will prefer it not be used in this species, however recent literature suggests that good outcomes can still be achieved<ref>[http://www.ncbi.nlm.nih.gov/pubmed/21194327]</ref>.Cellophane made from cellulose is a foreign material and is passed around the shunting vessel and secured in place to stimulate fibrosis, resulting in gradual occlusion. There is now a commercial supplier of cellophane for veterinary use<ref>[https://www.cellovet.com]</ref>.

*'''Partial ligation''' is achieved by applying a loose ligature to the shunt so that some blood flow still occurs.  In a proportion of animals, a complete ligation will then have to be performed at a later date.

*'''Partial ligation''' is achieved by applying a loose ligature to the shunt so that some blood flow still occurs.  In a proportion of animals, a complete ligation will then have to be performed at a later date.

|flashcards = [[Small Animal Soft Tissue Surgery Q&A 20]]

|flashcards = [[Small Animal Soft Tissue Surgery Q&A 20]]

|literature search = [http://www.cabdirect.org/search.html?q=%28%28title%3A%28Portosystemic%29+OR+title%3A%28Portocaval%29%29+AND+title%3A%28shunt%29%29+OR+title%3A%28%22Patent+Ductus+Venosus%22%29+OR+title%3A%28%22Portosystemic+Vascular+Anomal*%22%29 Portosystemic Shunt publications]

|literature search = [http://www.cabdirect.org/search.html?q=%28%28title%3A%28Portosystemic%29+OR+title%3A%28Portocaval%29%29+AND+title%3A%28shunt%29%29+OR+title%3A%28%22Patent+Ductus+Venosus%22%29+OR+title%3A%28%22Portosystemic+Vascular+Anomal*%22%29 Portosystemic Shunt publications]

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