Staff surgeon/Director of IR Service Animal Medical Center new york, New York, United States
Abstract: Introduction: Hepatic arteriovenous malformations (HAVM) are complex congenital vascular anomalies associated with varying degrees of liver dysfunction, hepatoencephalopathy, ascites, and failure to thrive. Due to high morbidity associated with hepatic lobectomy, alternative treatments including medical management, transarterial glue embolization (TAE), and dominant outflow vein (DOV) occlusion have been pursued. The goal of this study was to compare long-term outcomes in terms of patient survival following medical and various surgical techniques. MATERIALS & Methods: Medical records from an IR service were reviewed for all HAVM patients treated over a 20-year period. Information collected included patient signalment, presenting clinical signs, diagnostic imaging and biochemical findings, medical, surgical/interventional managements pursued with associated complications, and patient outcomes including medication requirements and median survival times (MST). Patients were excluded from the study if final follow-up information was less than 1 year or not available via contact with the client or referring veterinarian. Results: Forty-six patients were identified including 43 dogs and 3 cats. In dogs, medical management alone in 4 animals yielded a MST of 567d while surgery provided a MST of 1278d. While surgical complications and MST were not significantly different between the surgical treatment groups, the TAE group was significantly more likely to have remaining HAVM blood flow immediately after treatment (44% vs 5%) and experience HAVM recurrence (53% vs 15%) prompting additional treatments compared to the DOV group. Conclusion: Patients with HAVM may have improved outcomes following surgical treatment. TAE and DOV occlusion have similar overall outcomes but different recurrence rates.
Learning Objectives:
Learners will be able to describe the typical clinical signs, diagnostic findings, and physiological consequences associated with HAVMs in veterinary patients.
Learners will be able to contrast medical management, transarterial glue embolization (TAE), and dominant outflow vein (DOV) occlusion in terms of survival time, complication rates, and recurrence of HAVMs.
Learners will be able to analyze retrospective outcome data from a 20-year review to evaluate the effectiveness of different treatment approaches and guide future clinical decisions.
