Endovascular treatment of a high-flow hepatic arteriovenous malformation with secondary portal hypertension in a dog.

Abstract

CASE DESCRIPTION A 17-month-old neutered female Labrador Retriever with a 3- to 4-month history of abdominal distention was referred for evaluation and treatment. CLINICAL FINDINGS Evaluation of a peritoneal fluid specimen collected by the referring veterinarian indicated a pure transudate. At admission, transabdominal ultrasonography revealed microhepatica, dilation of the intrahepatic and mesenteric vasculature, peritoneal effusion, and multiple aberrant blood vessels. A large, high-flow hepatic arteriovenous malformation (HAVM) with secondary portal hypertension, peritoneal effusion, multiple acquired portosystemic shunts, and microhepatica was evident on CT angiography. TREATMENT AND OUTCOME Transfemoral hepatic arteriography and staged coil and glue (n-butyl cyanoacrylate) embolization of the complex arteriovenous malformation nidus and central main left hepatic artery resulted in ablation of the lesion, restoration of arterial blood flow to the contralateral hepatic lobes, and resolution of the peritoneal effusion. The dog remained without clinical signs of hepatic disease until it was euthanized 5 months after treatment for an unrelated condition. CLINICAL RELEVANCE Successful endovascular management of a HAVM was accomplished by means of coil and glue embolization in the patient of this report. Dogs with comparable HAVMs may benefit from similar minimally invasive treatment.