Kelley M. Thieman Mankin

Surgical management of an aberrant left subclavian artery originating from a left patent ductus arteriosus in a dog with a right aortic arch and abnormal branching.

An increase in the availability of advanced imaging modalities has led to improved recognition of cardiovascular anomalies. Computed tomography angiography (CTA) provides a non-invasive means of acquiring 3D images with a relatively short acquisition time thereby providing essential information in regards to patient anatomy and procedure planning. The dog in this report had a right aortic arch and abnormal branching with an aberrant left subclavian artery originating from the ampulla of a left patent ductus arteriosus (PDA) that was detected with CTA. The PDA was creating a volume overload to the left side of the heart as well as contributing to the vascular ring and compression of the esophagus. Therefore, ligation and transection instead of a minimally invasive catheter-based procedure was required. This aortic arch anomaly and surgical management have not been previously reported in dogs.

Frequency of Dehiscence in Hand-Sutured and Stapled Intestinal Anastomoses in Dogs.

OBJECTIVE To determine the frequency of dehiscence of hand-sutured and stapled intestinal anastomoses in the dog and compare the surgery duration for the methods of anastomosis. STUDY DESIGN Historical cohort study. SAMPLE POPULATION Two hundred fourteen client-owned dogs undergoing hand-sutured (n = 142) or stapled (n = 72) intestinal anastomoses. METHODS Medical records from 5 referral institutions were searched for dogs undergoing intestinal resection and anastomosis between March 2006 and February 2014. Demographic data, presence of septic peritonitis before surgery, surgical technique (hand-sutured or stapled), surgery duration, surgeon (resident versus faculty member), indication for surgical intervention, anatomic location of resection and anastomosis, and if dehiscence was noted postoperatively were retrieved. Estimated frequencies were summarized and presented as proportions and 95% confidence intervals (CI) and continuous outcomes as mean (95% CI). Comparisons were made across methods of anastomosis. RESULTS Overall, 29/205 dogs (0.14, 95% CI 0.10-00.19) had dehiscence, including 21/134 dogs (0.16, 0.11-0.23) undergoing hand-sutured anastomosis and 8/71 dogs (0.11, 0.06-0.21) undergoing stapled anastomosis. There was no significant difference in the frequency of dehiscence across anastomosis methods (χ(2), P = .389). The mean (95% CI) surgery duration of 140 minutes (132-147) for hand- sutured anastomoses and 108 minutes (99-119) for stapled anastomoses was significantly different (t-test, P < .001). CONCLUSION No significant difference in frequency of dehiscence was noted between hand- sutured and stapled anastomoses in dogs but surgery duration is significantly reduced by the use of staples for intestinal closure.

Primary splenic torsion in dogs: 102 cases (1992–2014)

OBJECTIVE To determine the percentage of dogs surviving to hospital discharge and identify factors associated with death prior to hospital discharge among dogs undergoing surgery because of primary splenic torsion (PST). DESIGN Retrospective case series. ANIMALS 102 client-owned dogs. PROCEDURES Medical records of dogs with a confirmed diagnosis of PST that underwent surgery between August 1992 and May 2014 were reviewed. History, signalment, results of physical examination and preoperative bloodwork, method of splenectomy, concurrent surgical procedures, perioperative complications, duration of hospital stay, splenic histopathologic findings, and details of follow-up were recorded. Best-fit multivariate logistic regression was performed to identify perioperative factors associated with survival to hospital discharge. RESULTS 93 of the 102 (91.2%) dogs survived to hospital discharge. German Shepherd Dogs (24/102 [23.5%]), Great Danes (15/102 [14.7%]), and English Bulldogs (12/102 [11.8%]) accounted for 50% of cases. Risk factors significantly associated with death prior to hospital discharge included septic peritonitis at initial examination (OR, 32.4; 95% confidence interval [CI], 2.1 to 502.0), intraoperative hemorrhage (OR, 22.6; 95% CI, 1.8 to 289.8), and postoperative development of respiratory distress (OR, 35.7; 95% CI, 2.7 to 466.0). Histopathologic evidence of splenic neoplasia was not found in any case. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the prognosis for dogs undergoing splenectomy because of PST was favorable. Several risk factors for death prior to discharge were identified, including preexisting septic peritonitis, intraoperative hemorrhage, and postoperative development of respiratory distress.

Comparison of Outcome After Use of Extra-Luminal Rings and Intra-Luminal Stents for Treatment of Tracheal Collapse in Dogs.

Objective To report short- and long-term complications and outcomes of dogs treated for tracheal collapse secondary to chondromalacia with extra-luminal rings (ELR) or intra-luminal stents (ILS). Study Design Retrospective cohort. Sample Population Dogs with naturally occurring tracheal collapse (n = 103). Methods Medical records (2002–2012) of dogs diagnosed with tracheal collapse that had treatment with ELR (n = 73) or ILS (30) were reviewed. Demographic information, procedural information, complications, survival time, and subjective outcomes were recorded. Follow-up periods were defined as 730 days (long-term). Results Ninety-two percent of dogs undergoing ELR and 100% of dogs undergoing ILS survived to hospital discharge. ELR dogs were significantly younger (P = .009) and significantly fewer had main-stem bronchial collapse (P < .001). After accounting for effects of age and presence of main-stem bronchial collapse, there was no significant difference in median survival time between groups. Dogs with main-stem bronchial collapse (regardless of treatment type) had a shorter survival time than dogs without main-stem bronchial collapse. Major complications occurred in ELR (42%) and ILS dogs (43%). Conclusions Both ELR and ILS are associated with high complication rates. Younger dogs and dogs without main-stem bronchial collapse had a longer survival time, regardless of treatment.OBJECTIVE To report short- and long-term complications and outcomes of dogs treated for tracheal collapse secondary to chondromalacia with extra-luminal rings (ELR) or intra-luminal stents (ILS). STUDY DESIGN Retrospective cohort. SAMPLE POPULATION Dogs with naturally occurring tracheal collapse (n = 103). METHODS Medical records (2002-2012) of dogs diagnosed with tracheal collapse that had treatment with ELR (n = 73) or ILS (30) were reviewed. Demographic information, procedural information, complications, survival time, and subjective outcomes were recorded. Follow-up periods were defined as <730 days (short-term) and >730 days (long-term). RESULTS Ninety-two percent of dogs undergoing ELR and 100% of dogs undergoing ILS survived to hospital discharge. ELR dogs were significantly younger (P = .009) and significantly fewer had main-stem bronchial collapse (P < .001). After accounting for effects of age and presence of main-stem bronchial collapse, there was no significant difference in median survival time between groups. Dogs with main-stem bronchial collapse (regardless of treatment type) had a shorter survival time than dogs without main-stem bronchial collapse. Major complications occurred in ELR (42%) and ILS dogs (43%). CONCLUSIONS Both ELR and ILS are associated with high complication rates. Younger dogs and dogs without main-stem bronchial collapse had a longer survival time, regardless of treatment.

Lung lobe torsion in dogs: 52 cases (2005-2017)

OBJECTIVE To report outcomes and risk factors for mortality in dogs that underwent surgical management of lung lobe torsion. STUDY DESIGN Retrospective case series from 5 veterinary teaching hospitals (2005-2017). ANIMALS Fifty dogs with 52 instances of lung lobe torsion. METHODS Data collected from medical records included signalment, clinical findings, results of clinicopathologic testing and diagnostic imaging, surgical treatment, lung lobe affected, intraoperative and postoperative complications, histopathologic and microbiologic findings, and outcome. Follow-up was obtained from medical records and telephone contact with primary care veterinarians. RESULTS Fifty-two instances of lung lobe torsion were identified in 50 dogs, with a median follow-up of 453 days (range, 0-3075). Forty-six (92%) dogs survived to discharge. Dogs with concurrent torsion of the right cranial and middle lung lobes were less likely to survive (2/4) than those with torsion of the left cranial lung lobe (22/22). No other risk factors for mortality prior to hospital discharge were identified. Overall median survival time after hospital discharge was 1369 days. Four dogs had >1 episode of lung lobe torsion. CONCLUSION The percentage of dogs surviving to discharge after surgical treatment of lung lobe torsion was higher than previously reported. The short- and long-term prognosis was excellent with surgical treatment of lung lobe torsion. CLINICAL SIGNIFICANCE Surgery should be recommended when lung lobe torsion is suspected because of the high survival to discharge rate and excellent long-term prognosis.

The impact of postdischarge surveillance on surgical site infection diagnosis

OBJECTIVE To evaluate the impact of postdischarge surveillance on surgical site infection (SSI) diagnosis. STUDY DESIGN Prospective enrollment with retrospective case review SAMPLE POPULATION: Dogs and cats (n = 1271) undergoing surgery April 2012-November 2013. METHODS The medical record of each animal was reviewed and a 30-day follow-up questionnaire was sent to each pet owner. A standardized definition of SSI was used to identify all animals with SSI. The method of SSI detection was recorded as: re-presentation to the hospital, scheduled recheck, questionnaire, communication with the referring veterinarian, or a combination of the above. RESULTS SSI was identified in 36 (2.83%) of the 1271 animals included. All SSIs were diagnosed after discharge from the hospital. Seven of the 36 animals with SSI were diagnosed at re-presentation to the hospital, 5/36 at scheduled recheck, 10/36 on questionnaire, 10/36 at re-presentation to the hospital AND on questionnaire, and 4/36 on communication with referring veterinarian. Of the diagnosed SSIs, 72.2% were documented in the medical record. Therefore, without active postdischarge surveillance, 10/36 SSIs (27.8%) would have gone unknown to surgeons at our institution. CONCLUSION Understanding the incidence of SSI with feedback to surgeons is an important aspect of an infection control program and has been shown to reduce SSI risks. Without active postoperative surveillance, 27.8% of SSIs would have gone unknown to surgeons. Implementing active surveillance will allow accurate reporting of incidence of SSIs in veterinary hospitals.

Long-term postoperative effects of administration of allogeneic blood products in 104 dogs with hemangiosarcoma: Ciepluch et al.

OBJECTIVE To determine the influence of administering allogeneic blood products (ABP) on the progression of hemangiosarcoma in dogs. STUDY DESIGN Multi-institutional, retrospective study. SAMPLE POPULATION One hundred four dogs with hemangiosarcoma that survived until postoperative discharge from the hospital. METHODS Medical records of dogs that had been operated on for hemoangiosarcoma were reviewed for signalment, presence of a hemoabdomen, presence of metastatic disease, and whether the dog had received chemotherapy or Yunnan Baiyao. Data that were collected were compared between dogs that received perioperative ABP and those that did not. Disease-free interval was compared between groups. The Kaplan-Meier method was used to obtain univariate descriptive statistics for time to clinical decline. A multivariable Cox regression model was used to analyze association or effect of potential predictor variables. RESULTS The median disease-free interval (DFI) was shorter in the 67 dogs that received a blood transfusion (76 days; range, 1-836) than in the 37 dogs that did not receive a blood transfusion (120 days; range, 38-916). According to the multivariable Cox regression model, administration of blood products (P = .04) and the presence of gross metastatic disease at the time of surgery (P < .01) shortened the DFI, whereas administration of Yunnan Baiyao (P = .01) prolonged the DFI. CONCLUSION Allogeneic blood product administration was associated with a shorter disease-free interval in this population. However, we could not demonstrate the association between blood products and shorter DFI because of confounding factors. CLINICAL SIGNIFICANCE Dogs that receive ABP at the time of surgical therapy for hemangiosarcoma may have accelerated disease progression compared with dogs that do not receive ABP.

Removal of hemangiosarcoma cells from canine blood with a cell salvage system and leukocyte reduction filter

OBJECTIVE To determine the ability of an intraoperative cell salvage (IOCS) system and a leukocyte reduction filter (LRF) to remove hemangiosarcoma (HSA) cells from canine blood. STUDY DESIGN Cultured HSA cells were added to canine blood to simulate intraoperative hemorrhage and address hemoabdomen from ruptured splenic HSA. The blood/HSA cell mixture was processed through an IOCS, followed by LRF processing. SAMPLE POPULATION Whole blood from 3 healthy dogs combined with cultured HSA cells. METHODS The ability of quantitative reverse transcriptase polymerase chain reaction (qRT-PCR), multiparameter flow cytometry, and cytologic examination to detect 50 HSA cells per milliliter of culture media was confirmed. RT-PCR, multiparameter flow cytometry, and cytologic examination were used to determine the presence of cultured HSA cells at 4 points during processing. RESULTS HSA cells were found in all control samples and in all samples after IOCS but prior to LRF processing with all 3 cell detection methods. HSA cells were not found after IOCS/LRF processing with all 3 cell detection methods. CONCLUSION IOCS combined with LRF processing is able to remove cultured HSA cells from canine blood. The addition of LRF to IOCS may allow application of IOCS in dogs with HSA. CLINICAL SIGNIFICANCE A combination of IOCS and LRF processing may provide an alternative to allogeneic blood transfusion in dogs with hemoabdomen due to HSA.

Owner Perception of Outcome Following Permanent Tracheostomy in Dogs

The purpose of this study was to evaluate owner perception of outcome following permanent tracheostomy (PT) in dogs. Medical records of dogs who received PT from 2002 to 2016 were reviewed. A questionnaire was given to owners verbally or by e-mail to ascertain their perception of their dogs outcome after PT. Median time to questionnaire administration from PT surgery was 608 days (64-3,708). Owner satisfaction after PT was high (89.7%), with the majority stating they would have the procedure performed again (79.5%). Owners reported an improvement in their dogs personality (30.8%) and increased activity (41%). Median survival time was 1,825 days (64-2,663), with 6 of 39 dogs (15.4%) alive at study end. Of the 33 dogs who died, 11 (33.3%) died from underlying respiratory conditions suspected to be related to the PT. The overall complication rate was 82.1%, with mucus secretion being the most common. Revision surgery was required in 30.8% of dogs (most commonly due to skin occlusion), and aspiration pneumonia occurred in 17.9% of dogs. Overall, owner satisfaction after PT in dogs is high despite intensive postoperative management, and long survival times can be achieved.

Likelihood and outcome of esophageal perforation secondary to esophageal foreign body in dogs

OBJECTIVE To determine the likelihood and outcome of esophageal perforation secondary to an esophageal foreign body (EFB) in dogs. DESIGN Retrospective observational study. ANIMALS 125 dogs evaluated for EFB at 2 veterinary teaching hospitals from January 2005 through December 2013. PROCEDURES Data were retrieved from the medical record of each dog regarding variables hypothesized to be associated with esophageal perforation, whether esophageal perforation was present, and survival to hospital discharge. Variables were examined for associations with various outcomes. RESULTS Bones (55/125 [44%]) and fishhooks (37/125 [30%]) were the most common types of EFBs. Fifteen (12%) dogs had an esophageal perforation (10 with a fishhook EFB and 5 with a bone EFB). No association was identified between dog body weight and esophageal perforation. Esophageal perforation was more likely in dogs with a fishhook EFB (10/37 [27%]) versus other EFBs (5/88 [6%]; OR, 6.1; 95% confidence interval, 1.9 to 9.6). Median interval from fishhook or bone ingestion to initial evaluation was significantly longer for dogs with (12 and 96 hours, respectively) versus without (1 and 24 hours, respectively) perforation. Thirteen of 15 (87%) dogs with esophageal perforation survived to hospital discharge, including all 10 dogs with perforation secondary to fishhook ingestion. Eight survivors with esophageal perforation required no surgical intervention. CONCLUSIONS AND CLINICAL RELEVANCE Esophageal perforation was uncommon in the evaluated dogs with an EFB, and no surgical intervention was required for a large proportion of them. Fishhooks and delay between EFB ingestion and initial evaluation were risk factors for perforation.