Intervention saves dogs with liver conditions at UF's Vet Med Center

When Delilah, a 6-month-old Labrador retriever, came to the University of Florida Veterinary Medical Center in July, she was much smaller than normal size for her breed and her liver had almost completely stopped functioning.

"From the beginning, we noticed that she was very sick," said Delilah's owner, Robin Fish of New Port Richey, adding that the AKC-registered chocolate Lab was one of 11 puppies in a litter the Fish family helped raise. "She'd snap back for a while, but never played like the other puppies and she was very listless. Soon after their second shots, she became extremely ill, with severe fevers."

Delilah had a congenital intrahepatic portosystemic liver shunt, a life-threatening condition through which blood bypasses the liver, leading to organ failure. Because surgery to treat these types of cases is extremely difficult and often not an option, as was the case with Delilah, UF veterinarians took a different approach, using minimally invasive interventional therapy to redirect blood flow through its normal channels.

Today, Delilah is one of two canine patients to have been successfully treated at UF for this condition through the use of interventional therapy, which uses diagnostic imaging to guide minimally invasive procedures.

In fact, Fish was so excited by Delilah's outcome at UF that she mentioned it to another couple she met at a social function whose dog suffered from the same condition.

That dog soon became UF's second success story for this particular type of treatment.

"People are excited about these new interventional techniques, but few veterinarians have the ability to do it just by themselves," said veterinary cardiologist Herb Maisenbacher, a clinical assistant professor of cardiology at the UF VMC whose primary interest is in vascular procedures. "I wouldn't attempt this unless surgeons or radiologists were there to help me. We all bring different skill sets to the table, which makes it possible."

Various specialized needles, introducers, catheters, guidewires and other devices are used to access the body in interventional therapies. Although interventional techniques have been used for years in human medicine, its use in veterinary medicine is in its infancy in many respects with only one formal training program in existence at the University of Pennsylvania — UF's VMC has implemented a team approach in which several specialty services are involved in the planning and execution of many interventional therapies.,/p>

"This approach has only improved the care of our patients and our ability to offer cutting edge treatment," Maisenbacher said. "It's a realm with a lot of promise and very few limitations. There are many organ system diseases that can be treated by these procedures."

UF cardiologists were trained three years ago by interventional veterinary specialist Chick Weiss from the University of Pennsylvania. Delilah's case gave the UF team its first opportunity to make use of these new skills. The procedure involves placing a wide-bore catheter in the jugular vein; using fluoroscopy, or real-time X-rays, to locate the vascular shunt; placing a metal stent in the vena cava and finally deploying coils to create the occlusion.

Interventional therapies generally include shorter hospital stays and reduced mortality rates, but most importantly, these techniques offer alternative treatments of conditions for which no standard treatments may exist, or for which the standard treatment — usually surgery — offers unacceptable risk. But the procedure's cost can be in the thousands of dollars.

"The metal stent alone costs $1,500," Maisenbacher said. "The good thing is, we can take a dog that is very sick and turn it into a healthy dog."

Veterinary radiologist Shannon Holmes said that currently interventional radiology is used at UF to treat intrahepatic portosystemic vascular anomalies, patent ductus arteriosus, tracheal collapse and urethral obstructions, and to deliver regional chemotherapy via arteries supplying a tumor.

"It truly is a team approach, as many specialists are often involved in the procedure," Holmes said. "It requires an excellent knowledge of three-dimensional radiologic anatomy and is an exciting field of radiologic practice that is rapidly expanding, especially in veterinary medicine."

As for Delilah, Fish said she is "doing beautifully."

"I told the doctors at UF, I didn't know what to do for them or how to thank them, so I just sent them another liver shunt dog so they could save another life," Fish said. "I was blessed enough to be able to give them another dog to help."