Page 17 - Eclipse - Autumn/Winter 2022

CLINICAL NEWS

CLINICAL NEWS Surgery for rare vascular malformation

of the Caudal Vena Cava

Lorna’s owners decided to go ahead
with surgery, and she returned for
admission in early July. Surgery was
performed by Dan Brockman, Professor
of Small Animal Surgery and Director
of the Cardiothoracic Surgery Service,
supported by third-year surgery resident
Carlos Alonso and third-year anaesthesia
resident Nuria Quesada Vicent.
Professor Brockman commented:
“Because of the history of trauma and
the high probability that Lorna had an
acquired traumatic kink in her caudal
year-old Rottweiler was treated Lorna’s clinical presentation was vena cava that was responsible for the
for an acquired traumatic kink comparable to dogs reported in post-sinusoidal venous hypertension,
in her caudal vena cava, which veterinary literature describing kinking we elected to explore the cava through
A was responsible for post- and tortuosity of the caudal vena cava. a right sixth intercostal thoracotomy.
sinusoidal venous hypertension. The Documented dogs often presented in At surgery, the scar tissue responsible
trauma was most likely caused by an young adulthood following blunt thoracic for the ‘kink’ was obvious and
altercation with a deer. trauma. Lorna’s possible altercation with incorporated the right phrenic nerve,
a deer, coupled with evidence of rib
Lorna was referred to the Emergency fractures, mirrored those cases. which was discontinuous.
and Critical Care Service early last May “Having released the cava from the
with ascites and suspected right-sided Possible treatments included surgical scar tissue, the caudal caval pressure
cardiac failure. On presentation she exploration and resection of the scar remained slightly above cranial caval
was alert and cardiovascularly stable. tissue causing obstruction, resection of pressure, so a patch of pericardium
Ultrasound confirmed the presence the narrow part of the caudal cava and was sutured into a longitudinal incision
of fluid in her abdomen. Radiographs catheter-guided balloon dilation of the across the stricture, made in the caudal
revealed rib fractures. lesion with stent placement. Nobody at cava made inside a carefully positioned
the RVC had performed treatment on
An echocardiogram revealed an Satinsky clamp. This reduced the caudal
abnormal structure at the base of her such a lesion but they suspected that caval pressure such that it was just
heart. A case conference involving balloon dilation and/or stenting would above mean cranial caval pressure.”
cardiology and surgery was held and be less appropriate as the kinking of Lorna recovered uneventfully and was
the conclusion was that the lesion was the vena cava was likely associated discharged on antiplatelet drugs for
either a rare congenital or acquired with fibrous tissue causing extra-luminal a month, to reduce the risk of clots
vascular malformation. CT confirmed a compression and there would be a high forming on the pericardial patch. She
malformation of her caudal vena cava, risk of recurrence. They also preferred did well at home and, when returning for
resulting in high pressure, which was to avoid an intravascular implant in such check-up, the team found no evidence
the cause of her ascites. Her heart was a young dog. of congestion of the abdominal aorta or
found to be otherwise normal in structure.
hepatic veins and no ascites.

CT angiogram reconstruction of kinked vena cava

17