Computed tomographic-derived measurements of shunt fraction and hepatic perfusion in dogs with a single extrahepatic portosystemic shunt in a clinical setting

OBJECTIVE

To evaluate the clinical feasibility and usefulness of measuring shunt fraction (SF) and hepatic perfusion with CT in dogs with a single extrahepatic portosystemic shunt (EPSS).

ANIMALS

36 client-owned dogs with EPSS.

PROCEDURES

Dogs with EPSS referred for treatment between February 2016 and May 2017 were eligible for the clinical trial. Shunt type, SF, and hepatic perfusion were determined in each dog with a 320-row multidetector CT scanner, and surgical treatment was performed by a single veterinary surgeon. Differences in results between dogs grouped according to age (< 3 years vs ≥ 3 years), shunt type, and subgroups (eg, clinical signs and surgical procedure) were analyzed, and correlations between the SF and hepatic perfusion variables were evaluated.

RESULTS

The median SF was higher in dogs < 3 years old (74.6%; n = 18) versus dogs ≥ 3 years old (35.1%; 18). Correlations were identified between SF and hepatic perfusion variables, and differences in results for SF and hepatic perfusion variables were detected between dogs grouped according to shunt type.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that CT-derived measurements of SF and hepatic perfusion variables in dogs with EPSS were feasible and could be useful (eg, estimating EPSS condition status and planning treatment) in clinical settings. In addition, our findings suggested that perfusion CT could be useful for distinguishing hemodynamic characteristics among different types of portosystemic shunts in dogs.

Portosystemic shunts in cats--evaluation of six cases and a review of the literature

The objective of this study was to give a recent review of the literature of portosystemic shunt (PSS) in cats and to describe a case series of 6 cats diagnosed with PSS. Cats diagnosed with a PSS between 1997 and 2006 were reviewed with a focus on history, clinical signs, laboratory findings, imaging techniques, and outcome. Among 12,438 analysed cats, six cats were found with confirmed PSS (one portocaval, two intrahepatic, and three portoazygos shunts) leading to a prevalence of PSS in cats of 4.8/10,000 (0.048%) when compared to the clinic population. Three of the cats were purebred; four were male and two female. Median age at time of diagnosis was four months. All cats showed signs of hepatoencephalopathy and elevated fasted serum bile acids. Elevated fasted ammonia levels were found in five of six cats. Abdominal ultrasonography showed the shunting vessel in four of six cats. Three of four cats in which the shunt was surgically attenuated had a good to excellent outcome (follow up of 65 months). In conclusion PSS are rare in cats. Affected cats may have an excellent long term outcome with surgery.

Acquired extrahepatic portosystemic shunts in a young dog

A young, male miniature poodle was presented with severe neurological problems. Laboratory tests and ultrasonograph examination were consistent with extrahepatic portosystemic shunts, resulting in hepatic encephalopathy. When surgical correction proved not to be a viable option, the dog was euthanized. Postmortem examination revealed multiple shunts likely acquired after severe hepatitis.

Diagnostic value of fasting plasma ammonia and bile acid concentrations in the identification of portosystemic shunting in dogs

Portosystemic shunting occurs frequently either as congenital anomalies of the portal vein (PVA) or as acquired shunting (AS) due to portal hypertension secondary to parenchymal liver disease or portal vein thrombosis. The 2 most commonly used screening tests for portosystemic shunting are bile acid and plasma ammonia concentrations. The purpose of this study was to compare the 12-hour fasting plasma ammonia (AMM) and bile acid concentration (BA) as tests for diagnosing portosystemic shunting. Medical records of 337 dogs were used in which AMM and BA were measured simultaneously and in which portosystemic shunting was confirmed or excluded. These dogs were divided into 2 groups (group 1: portosystemic shunting present, n = 153, and group 2: portosystemic shunting absent, n = 184). Group 1 was subdivided into 2 subgroups (group 1a: PVA, n = 132 and group 1b: AS, n = 21). The sensitivity of AMM in detecting PVA was 100% and of BA was 92.2%. For portosystemic shunting in general (PVA or AS), the sensitivity of AMM was 98% and that of BA was 88.9%. The specificity in the total population of AMM was 89.1% and that of BA was 67.9%. If only dogs with liver diseases were included with (n = 153) or without (n = 28) shunting, the specificity of AMM to detect shunting was 89.3% and that of BA was 17.9%. In conclusion, AMM is a highly sensitive and specific parameter to detect PVA and portosystemic shunting in a general population and in dogs with liver disease, whereas BA is somewhat less sensitive and considerably less specific.

cis-Atracurium in dogs with and without porto-systemic shunts

OBJECTIVE

To evaluate the non-depolarizing neuromuscular blocking drug cis-atracurium in dogs with porto-systemic shunts, and to compare it in clinically normal animals.

ANIMALS

Thirteen dogs of mixed breed and sex, aged between 3 and 31 months old, weighing 2.2-25.5 kg, with ASA physical status II-IV, and undergoing surgical attenuation of porto-systemic shunt. A control group of 11 bitches of mixed breed, between 8 and 60 months old, and weighing 4.5-41.0 kg, all ASA physical status I, undergoing routine ovarohysterectomy were also studied.

MATERIALS AND METHODS

Pre-anaesthetic medication was an opioid analgesic, given either alone or in combination with acepromazine. Following induction of general anaesthesia with intravenous (IV) propofol and oro-tracheal intubation, anaesthesia was maintained using isoflurane in either oxygen or oxygen and nitrous oxide. Ventilation was controlled. The train of four (TOF) technique was used to monitor neuromuscular blockade. An initial dose of 0.1 mg kg(-1)cis-atracurium was given IV and additional doses of 0.03 mg kg(-1)cis-atracurium were administered when at least one twitch of the TOF was present.

RESULTS

Except for one dog that was killed during surgery because its anomaly was inoperable, all animals recovered satisfactorily from anaesthesia and surgery. In dogs with porto-systemic shunt, onset of neuromuscular blockade was 3.1 +/- 1.1 minutes (mean +/- SD) and in control dogs was 3.4 +/- 0.7 minutes (not significantly different). Neuromuscular blockade lasted 34 +/- 13 minutes in dogs with porto-systemic shunt and 29 +/- 17 minutes in control dogs (not significantly different).

CONCLUSIONS

The presence of porto-systemic shunt did not affect the rate of onset or duration of action of cis-atracurium.

CLINICAL RELEVANCE

cis-Atracurium may have a use in veterinary anaesthesia for producing neuromuscular blockade in dogs with hepatic insufficiency, including those with porto-systemic shunt.

BRAIN MAGNETIC RESONANCE IMAGING CHARACTERISTICS IN DOGS AND CATS WITH CONGENITAL PORTOSYSTEMIC SHUNTS

Animals with a portosystemic shunt (PSS) often have neurologic abnormalities. Diagnostic imaging, including brain magnetic resonance (MR) imaging, is not performed routinely in these animals. In this study, brain MR images were obtained in 13 dogs and three cats with a PSS, and in 15 dogs and five cats that were neurologically normal and used as controls. All animals with a PSS had widened sulci. In addition, 10 out of 13 dogs with a PSS and one out of three cats with a PSS had hyperintense focal areas in the lentiform nuclei on T1-weighted (T1W) images, which did not enhance after intravenous gadolinium. Following surgical correction of the PSS, MR imaging examinations were repeated in one dog and one cat. The hyperintensity of the lentiform nuclei had decreased. This study indicates that MR imaging findings of widened sulci and hyperintensity of the lentiform nuclei on T1W images may be found in dogs and cats with a PSS.

DIAGNOSIS OF ARTERIOPORTAL FISTULAE IN FOUR DOGS USING COMPUTED TOMOGRAPHIC ANGIOGRAPHY

Arterioportal fistulae are rare congenital anomalies of the hepatic vasculature. Diagnosis is conventionally made by selective angiography or ultrasonography. This report describes use of a dual-phase computed tomographic (CT) angiographic technique to diagnose arterioportal fistulae in four dogs. Advantages of this method include a noninvasive peripheral injection of contrast medium, ability to diagnose multiple acquired extrahepatic shunts, and observation of hemodynamic changes such as hepatofugal blood flow and reduced circulation to the caudal abdomen. The hepatic vasculature including arteries, veins, and portal veins can be completely evaluated. Dual-phase CT angiography is a safe and minimally invasive method of diagnosing arterioportal fistulae in dogs.

An Evaluation of Radiographic Hepatic Size in Dogs with Portosystemic Shunt

Radiographically, the hepatic sizes of portosystemic shunt (PSS) cases were evaluated. In this study the hepatic area was compared in PSS and non-PSS dogs by utilizing the right lateral radiography. The top three breeds of PSS dogs of Maltese, Shih Tzu and Yorkshire Terrier, were included and these dogs had a significantly smaller hepatic area ratio of 46.37 +/- 0.63%, 61.76 +/- 0.78% and 41.59 +/- 0.23% respectively (p<0.05) and the average overall hepatic area in the 3 dog breeds was 47.75 +/- 0.40%.

Helical computed tomographic portography in ten normal dogs and ten dogs with a portosystemic shunt

Contrast enhanced helical computed tomography (CT) of the liver and portal system is routinely performed in human patients. The purpose of this project is to develop a practical protocol for helical CT portography in the dog. Ten clinically normal dogs were initially evaluated to develop a protocol. Using this protocol, ten dogs with confirmed portosystemic shunts (PSS) were then evaluated. Each patient was anesthetized, and a test dose of sodium iothalamate (400 mg I/ml) at 0.55 ml/kg was injected. Serial images were acquired at the level of T12-13 or T13-L1. The time to maximum enhancement of the portal vein was determined. This time period was used as the period between the second injection (2.2 ml/kg) and the start of the helical examination of the cranial abdomen. Delay times for normal dogs ranged from 34.5 s-66.0 s (median: 43.5 s) or 1.41 s/kg-4.12 s/kg (median: 2.09 s/kg). For patients with a PSS, the delay times were 16.5-70.5 s (median: 34.5 s) or 1.47-19.17 s/kg (median: 3.39 s/kg). The aorta, caudal vena cava, portal vein, shunt vessels, and their respective branches were well visualized on the CT images. Clinical case results were surgically confirmed. The surgeons reported that the information gained from the CT portography resulted in a subjective decrease in surgical time and degree of dissection necessary compared with similar surgeries performed without angiographic information. We believe that helical CT portography in the dog will be a useful adjunct in the diagnosis of PSS. The use of helical CT portography may allow clinicians to give clients a more accurate prognosis prior to surgery and will allow patients with lesions that are not surgically correctable to avoid a costly and invasive procedure.

Cellophane banding of congenital intrahepatic portosystemic shunts in two Irish wolfhounds

Two three-month-old, male Irish wolfhound siblings were diagnosed with breed-typical left divisional congenital intrahepatic portosystemic shunts consistent with patent ductus venosus. The shunts were amenable to surgical dissection at a posthepatic location. Both dogs had cellophane banding for shunt attenuation. One dog was euthanased after developing post-ligation neurological dysfunction, which was refractory to treatment. The other dog survived and demonstrated shunt attenuation. Successful surgical management using cellophane banding of a patent ductus venosus has not been previously described in a large-breed dog.

Anatomy of the patent ductus venosus in the cat

The biplanar mesenteric vein portovenograms of 10 cats with left divisional intrahepatic portosystemic shunts consistent with a patent ductus venosus (PDV) were reviewed. A corrosion cast of the hepatic portal vasculature was made post mortem from one individual that died post operatively following surgical attenuation of the shunting vessel. On the basis of the combined surgical, post mortem and imaging data, these left divisional shunts were found to have consistent anatomy, each having a straight vessel which drained into a venous ampulla before draining into the caudal vena cava at the level of the diaphragm. The left phrenic vein and left hepatic vein both entered the ampulla independently of the shunting vessel. The anatomical similarity between these findings in the cat and the PDV in the dog suggest that it is appropriate to describe this particular portosystemic shunt as a PDV.

Iron status and erythrocyte volume in dogs with congenital portosystemic vascular anomalies

Microcytosis, hypochromasia, and low mean corpuscular hemoglobin are frequent hematologic abnormalities in dogs with portosystemic vascular anomalies (PSVA). The relationship of iron status to these abnormalities is unclear. We evaluated iron status and hematologic and biochemical parameters in dogs with congenital PSVA before (25 dogs) and after (11 dogs) partial ligation of the vascular anomaly. Serum iron concentration and total iron binding capacity were subnormal in 56% and 20% of dogs with PSVA, respectively. Transferrin saturation was normal in 68%, decreased in 20%, and increased in 12% of the dogs. Plasma ferritin concentration was either normal (56%) or high (44%), and was not associated with increases in ceruloplasmin concentration. Hepatic stainable iron was increased in 10 of 16 dogs. Mean corpuscular volume (MCV), mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration were decreased in more than 60% of dogs with PSVA. Serum biochemical abnormalities included high bile acid concentration and alanine transaminase (ALT) and alkaline phosphatase (ALP) activities; and low urea, creatinine, cholesterol, and total protein concentrations. Serum iron concentration and clinical status (normal or PSVA) significantly influenced MCV (P = .003 and P < .001, respectively), whereas age, ceruloplasmin, ferritin, cholesterol, bile acids, and total iron binding capacity did not. Partial ligation of PSVA was associated with resolution of clinical signs and the return to normal of iron status and all clinicopathologic abnormalities, except total fasting bile acid concentrations. These findings indicate that iron status is frequently abnormal in dogs with PSVA and that low serum iron concentration appears to be related to the development of microcytosis. The normalization of iron status and clinicopathologic abnormalities after treatment suggests that they are direct consequences of PSVA.

Endotoxemia associated with experimentally induced multiple portosystemic shunts in dogs

OBJECTIVE

To document presence of endotoxin in portal and systemic blood in a model of canine multiple portosystemic shunts (PSS), and compare values in clinically normal dogs, before and after vena caval banding.

ANIMALS

6 control dogs and 10 dogs with dimethylnitrosamine-induced multiple PSS that were subjected to vena caval banding.

PROCEDURE

Dimethylnitrosamine was administered orally (2 mg/kg of body weight, twice weekly) to the 10 dogs in the diseased group until multiple PSS developed. Surgery was then performed on all 16 dogs (both groups), and shunts were confirmed in the diseased dogs. Blood was collected from the portal vein, hepatic vein, and caudal vena cava baseline endotoxin determination and aerobic and anaerobic blood culturing. Baseline pressure measurements were taken from the portal venous catheter; then vena caval banding was performed. Blood for endotoxin determinations was taken from all vessels 20, 40, 60, 120, 240, and 360 minutes after banding; portal pressure measurements were taken at the same time as sample acquisition. Blood for culturing was taken from the portal and hepatic venous catheters at 120, 240, and 360 minutes after banding.

RESULTS

Dogs in the diseased group had significantly greater overall presence of endotoxin in the portal vein (P < or = 0.0002), hepatic vein (P < or = 0.0001), and caudal vena cava (P < or = 0.0004) than did control dogs. With respect to time, endotoxin presence was greater in the diseased group before banding (P < or = 0.0002), and at 20 (P < or = 0.0008), 40 (P < or = 0.002), 60 (P < or = 0.006), and 120 (P < or = 0.01) minutes after banding.

CONCLUSIONS

Endotoxemia is more frequently present in catheterized dogs with dimethylnitrosamine-induced hepatic disease and multiple PSS, compared with clinically normal dogs. Additionally, portal pressure changes induced by vena caval banding did not affect endotoxemia.

CLINICAL RELEVANCE

Endotoxemia may exist in dogs with hepatic disease and multiple PSS, and should be kept in mind when formulating treatment (particularly antimicrobial selection) for dogs with suspected endotoxemia.

Gradual occlusion of extrahepatic portosystemic shunts in dogs and cats using the ameroid constrictor

Gradual occlusion of the splenic vein, using a specialized device (ameroid constrictor), was evaluated experimentally in three normal beagle dogs. Splenoportograms were used to verify that total occlusion of the splenic vein had occurred in all dogs within 4 to 5 weeks after application of the device. The ameroid constrictor (AC) was also evaluated as a method of gradual vascular occlusion in 12 dogs and two cats with single, extrahepatic, portosystemic shunts (PSS). Serum bile acid (SBA) concentrations were measured and portal scintigraphy (PS) was performed on all 14 animals preoperatively and 10, 20, 30, and 60 days postoperatively. Two dogs (14%) died from portal hypertension in the early postoperative period. One dog and one cat developed multiple acquired PSS, confirmed by mesenteric portography 90 days after the operation. Portal scintigraphy confirmed total occlusion of the primary shunt in the other 10 animals. Shunt fractions (SF), as measured by PS on postoperative days 30 and 60, declined significantly from preoperative values. Significant decreases were noted between preoperative and postoperative values for preprandial SBA on postoperative day 60 and for postprandial SBA on postoperative day 30. SBA concentrations did not correlate with SF. Based on this study, gradual vascular occlusion using the AC is recommended as a method for treatment of single, extrahepatic, PSS.

Surgical treatment of intrahepatic portosystemic shunts in six cats

The surgical treatment of intrahepatic portosystemic shunts in six cats is described. The preoperative diagnoses were based on the results of abdominal ultrasonography, and mesenteric portography was used during surgery to confirm the diagnosis and establish the morphology of the shunting vessel. In four of the cats the shunt vessel passed through the left division of the liver, compatible with a patent ductus venosus (PDV), in one cat the shunt passed through the central hepatic division and in the other cat it passed through the right hepatic division. During surgery the shunt vessel was manipulated directly either intrahepatically, or post hepatically in the four cats with PDV. In five cats the shunt vessel was partially ligated, and in the other the vessel was completely ligated. The attenuation procedure produced a mean increase in mesenteric venous pressure of 17 cm H2O, with a range from 14 to 20 cm. All the cats recovered from the surgical procedure, but one developed neurological signs shortly after the operation and died from respiratory failure. Four of the cats were clinically normal and required no medication by one month after the operation. One cat required long-term medication to control its continued clinical signs.

Characterization of hepatoportal microvascular dysplasia in a kindred of cairn terriers

Hepatoportal microvascular dysplasia (MVD), a congenital disorder of the hepatic vasculature, is described in a kindred of Cairn Terrier dogs. Cairn Terrier dogs (n = 165) were evaluated using the serum bile acid test. Affected dogs, identified by abnormal fasting or postprandial serum bile acid concentrations, were divided into 2 groups. Group 1 dogs (n = 147) were used for pedigree analysis. Group 2 dogs (n = 18) were characterized on the basis of history, physical examination, clinicopathologic studies, diagnostic imaging of the liver and portal circulation, and hepatic histopathology. Group 2 contained control dogs (n = 2), dogs with hepatoportal MVD (n = 11), and dogs with macroscopic portosystemic vascular anomalies (PVSA) (n = 5). With the exception of high serum bile acid concentrations, dogs with hepatoportal MVD were indistinguishable from control dogs on the basis of history, physical examination, clinicopathologic findings, survey abdominal radiography, abdominal ultrasound, or transcolonic scintigraphy. Contrast portography in dogs with MVD revealed abnormalities of terminal twigs of the portal vasculature with out large intrahepatic or extrahepatic shunting vessels. Histopathologic abnormalities in dogs with hepatoportal MVD were similar to those reported for dogs with PSVA. Pedigree analysis suggested an autosomal inheritance for MVD. Dogs with MVD had high serum bile acid concentrations, abnormal indocyanine green clearance, and hepatic pathology suggestive of PSVA, but they lacked characteristic clinical findings of PSVA. The clinical significance of MVD is unclear. Dogs with MVD were clinically normal when evaluated but long-term follow-up is not yet available. Dogs with hepatoportal MVD should be identified at an early age to avoid confusion in future diagnostic evaluations.

Use of technetium-99m sulfur colloid to evaluate changes in reticuloendothelial function in dogs with experimentally induced chronic biliary cirrhosis and portosystemic shunting

Technetium-99m sulfur colloid scintigraphy was used to study alterations of reticuloendothelial function in 7 dogs with experimentally induced biliary cirrhosis and portosystemic shunting. Scintigraphic studies were performed before and 6 weeks after common bile duct ligation. Radiocolloid plasma clearance rate was determined by measuring activity in plasma samples and by analyzing the rate of liver uptake on dynamic scintigraphic image sequences. Percentage of uptake in the liver, spleen, and lungs, as well as the ratio of hepatic-to-extrahepatic uptake, was determined from static equilibrium images. Relative to preoperative values, there were significant decreases in plasma clearance rate, percentage of liver uptake, and ratio of hepatic-to-extrahepatic uptake and significant increases in percentage of spleen and lung uptake on postoperative studies. The mechanism of technetium-99m-labeled sulfur colloid extraction by the liver is different from that of other radiocolloids; it does not require active phagocytosis or pinocytosis. Thus, liver uptake of this tracer principally reflects effective liver blood flow. Portosystemic shunting was documented in these dogs at the time of the postoperative radiocolloid scans, and we believed was responsible for the decrease in liver reticuloendothelial activity. Possible mechanisms for the increased splenic and pulmonary reticuloendothelial activities are discussed.

Quantitation of portosystemic shunting in dogs by ultrasound-guided injection of 99MTc-macroaggregates into a splenic vein

A technique is described for the ultrasound-guided injection of 99mTc-macroaggregates into a splenic vein in order to quantitate portosystemic collateral circulation. The fraction of portal blood by-passing the liver was derived from the radioactivity trapped in the liver and lungs and was expressed as the shunt index (SI). The method was tested in healthy dogs without shunting, and in dogs with single hereditary portosystemic shunts before and one month after surgical closure of the shunt. The mean SI was 0.01 (range 0.01 to 0.05) in healthy dogs and 0.94 (0.69 to 1.00) in dogs with hereditary shunts. After partial closure of the shunts the SI decreased to 0.25 (0.03 to 0.70). There was a significant positive correlation between the logarithms of the concentration of ammonia in plasma and the SI (r = 0.87, P < 0.001).

Transsplenic portal catheterization. Surgical technique and use in two dogs with portosystemic shunts

The portal vasculature can be accessed by using a through-the-needle catheter system to pass a catheter through the splenic parenchyma and into a major splenic vein at the hilus. The authors have termed this technique transsplenic portal catheterization (TPC). Transsplenic portal catheterization is indicated for portal angiography, portal pressure measurement, and chronic portal blood sampling. Clinical applications of this technique include use in diagnosis and surgical management of portosystemic shunts and differentiation of prehepatic, hepatic, and posthepatic hypertension. This report describes the technique of transsplenic portal catheterization. Clinical use of this technique in two cases of portosystemic shunts are included.

Apparent dietary protein requirement of dogs with portosystemic shunt

Current medical management of dogs with portosystemic shunt (PSS) includes dietary protein restriction. After establishment of baseline values, 32 dogs underwent portosystemic anastomosis to induce PSS. They were assigned to 1 of 4 dietary treatments, and given 11 or 24% crude protein (CP); 20% of the protein was derived from branched chain or aromatic amino acids. The apparent digestibility of CP and of total digestible energy were not affected by PSS. The apparent digestibility of fat decreased from 92% to 85% in dogs with PSS (P < 0.01). Across all diets, the apparent dietary protein requirement (ADPR) was 2.07 g of CP/kg of body weight/d in clinically normal dogs and 2.11 g of CP/kg/d after PSS. Dietary amino acid composition had no effect on ADPR. The ADPR for dogs fed the 11% protein diets was 1.69 g of CP/kg/d in clinically normal dogs and 1.62 g of CP/kg/d after PSS, whereas the ADPR in dogs fed the 24% protein diets was 3.94 g of CP/kg/d before PSS and 3.31 g of CP/kg/d after PSS. Serum total protein, urea nitrogen, and albumin concentrations were lower in dogs with PSS fed the 11% protein diets, compared with those fed the 24% protein diets. We conclude that there is no difference in ADPR in dogs with PSS; however, the low protein intake of 1.62 g of CP/kg/d appeared inadequate to maintain normal protein stores. Dietary protein that provides at least 2.1 g of CP/kg/d is recommended for dogs with PSS.

Endotoxin concentrations measured by a chromogenic assay in portal and peripheral venous blood in ten dogs with portosystemic shunts

A chromogenic Limulus amebocyte lysate assay was used to measure portal and peripheral venous endotoxin concentrations in ten medically managed dogs undergoing surgery for correction of a single extrahepatic portosystemic shunt. In all dogs, both peripheral and portal venous blood samples were obtained at the time of surgical manipulation of the anomalous vessel. In six dogs, peripheral venous samples were obtained an average of 8.0 months after surgery. Five physically normal dogs without biochemical or histologic evidence of liver disease served as controls. Data analysis failed to demonstrate significant differences in peripheral and portal venous endotoxin concentrations between the control and study groups. Postoperatively five of six dogs showed a measurable reduction in peripheral venous endotoxin concentration over intraoperatively obtained values, but the differences were not statistically significant (P = 0.06). Based on results of this study it was concluded that systemic endotoxemia was not present in dogs with a single extrahepatic portosystemic shunt that were medically stable prior to surgery.