Archive for the Interventional Radiology Category

Removing Stones from Strawberry

Strawberry

Strawberry, a three-year-old female guinea pig, was seen by Dr. Olivia Petritz, our board-certified exotics specialist. Strawberry presented for an evaluation of a bladder stone, which had been diagnosed by her primary veterinarian. After consulting with Dr. Branter, the head of Interventional Radiology/Endoscopy and Urology, Strawberry’s family decided to try to remove the stone without surgery.

Using a small, rigid cystoscope and basket specialized for stone removal, Dr. Branter was able to retrieve the stone and avoid an invasive surgical procedure. The stone was analyzed and the results showed that it was composed of calcium carbonate, which is the most common type of stone in guinea pigs.

Strawberry recovered much more quickly than if she had undergone surgery. She was sent home soon after the scope with antibiotics and pain medication to recover with her family. She will have periodic x-rays to check for the formation of new stones, which will allow us to find any future stones early enough to remove them with an even less invasive method called voiding urethral hydropulsion, or flushing out of stones.

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Interventional Radiology with Bentley…

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Bentley, a seven-year-old St. Bernard mix, came to ACCESS Specialty Animal Hospital – Los Angeles for weight loss due to vomiting as well as nasopharyngeal stenosis, which is a narrowing behind the two nasal passages that brings air from the nose to the trachea.

Bentley had a prior amputation surgery and had an episode where gastric fluid showered to the nasopharynx causing inflammation and scarring, which greatly affected him, as the scarring had closed his nasopharynx. Bentley could not pass air with his mouth closed and he was struggling to breathe when sleeping. A scope was performed at his primary veterinarian’s office, and Bentley was then referred out to ACCESS for further work up.

After meeting with Dr. Erinne Branter and being presented with all of their options, Bentley’s parents decided to go with a minimally invasive procedure that would correct the narrowing in Bentley’s nasal passages and allow him to breathe easier.

Dr. Branter and her team installed a fixed-wire balloon stent into the nasopharyngeal stenosis, or stricture, at the soft palate, as well as instilled a drug called Triamcinolone into the region to prevent further issues. Bentley’s esophagitis was totally resolved with scoping and medications.

Bentley did great under anesthesia and did not have any complications. He was finally able to breathe comfortably while sleeping and was placed on medications to treat his IBD and esophagitis. He may need further balloon procedures, which is why his balloon was installed. This allows for future procedure to be performed as needed.

Award Nods reach Culver City…

Dr. Erinne Branter, head of the Interventional Radiology/Endoscopy department at ACCESS Specialty Animal Hospital in Los Angeles, was nominated for the Pet Plan Veterinarian of the Year award!

This is such an honor, as nominations are made by pet owners and community members. We would like to congratulate all of the winners of the Pet Plan awards this year and look forward to the 2017 nominations!

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Fendi: The Dog with A Collapsed Trachea.

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Fendi is a 12.5 year-old female spayed Maltese who was referred to Dr. Erinne Branter in the ACCESS Los Angeles interventional radiology/endoscopy department for severe coughing for a week.

She was very uncomfortable and had not been able to rest or sleep due to the severity of her cough. She was found to have a collapsing trachea, which was causing the coughing. The trachea, or “windpipe,” is a tube made up of rings of cartilage, through which air is transported to and from the lungs. Sometimes though, the tracheal rings begin to collapse, and as air is squeezed through, a characteristic honking cough results.

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Figure 1 – tracheal collapse mid trachea

Fendi had been placed on medications to help her condition but was not responding well. Her family then decided to proceed with a stenting procedure to help open up Fendi’s trachea.
Tracheal stents are placed in a minimally invasive fashion with no incision and traditional neck ring placement surgeries are not necessary. The stents are placed through the mouth and into the trachea to open the collapsed airway. This allows airflow into the lungs and typically makes it possible for these patients to stop coughing and breathe more easily.

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Figure 2 – post tracheal stent with open tracheal

Fendi was able to go home the next day on medical management for her tracheal collapse and has slowly been weaned off of most of her medications. Her tracheal stent does not impact her daily activities, but it does now allow her to breathe easier and gives her a chance at a longer life with her loving family.

Belly full of metal…

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Dr. Erinne Branter and Koda

 
Belly Full Of Metal Leads To Diagnosis Of A Congenital Liver Shunt.
Koda’s Second Chance!

Koda Taylor, a striking, young Siberian Husky, was living in a local shelter when his new mom found him, hours before he was scheduled to be euthanized. After being adopted, Koda was taken to a primary veterinarian for an examination, as his history was unknown and his new family wanted to make sure he was getting the best start to his new life.

During the exam, the doctor noticed something wasn’t right. After some x-rays were done, it was revealed that Koda had a ton of metal in his belly! A buckle, a bolt, some pins, parts of leashes—it was apparent that this pup need help and quick! Koda had surgery done with his primary veterinarian to remove the foreign objects and the surgery was successful, but something still wasn’t right. Koda went on to see several primary care veterinarians, a few told his mom to euthanize because something was wrong with him mentally.

A buckle, a bolt, some pins, parts of leashes—it was apparent that this pup need help and quick!
Koda’s mom had a hunch that this pup had something else going on, so she continued on, and found a neurologist to evaluate his abnormal behavior. The neurologist referred them to an internal medicine specialist who finally saw what was causing the trouble, this time, it was Koda’s liver.

Koda’s liver was small and his bloodwork revealed his liver values were very high. His internist diagnosed him with liver shunt, an intrahepatic portosystemic shunt, to be exact. A liver shunt is a blood vessel that carries blood around the liver instead of through it. In some animals, they are born with a liver shunt (congenital) though in others, multiple small shunts can form because of severe liver disease. If left untreated, a liver shunt can cause toxins to build up in the bloodstream or kidneys as well as abnormal behavior, and eventually liver failure. Koda was prescribed a strict diet and medications to help him through the time between the diagnosis and his next appointment and was referred to Dr. Erinne Branter, an internal medicine specialist and the head of the Interventional Radiology and Endoscopy Department at ACCESS LA.

Dr. Branter recommended a contrast CT angiogram and this found that young Koda had one large right sided shunt. Options were discussed with Koda’s family such as; surgery and medical management vs. a minimally invasive approach via a percutaneous transjugular coil embolization, or PTCE. They agreed that the best choice for their family and Koda would be the PTCE, which is a minimally invasive procedure that would correct the intrahepatic portosystemic shunt in Koda’s liver with much less risk than traditional surgery.

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Between the adoption fees, foreign body removal, examinations, medications, CT scans, and more, the bills were starting to pile up. Wanting to provide her sweet pup with the best care possible, Koda’s mom looked for help with a group of local Husky lovers. They helped her create social networking pages to raise money and awareness for Koda, who was suffering from a congenital liver shunt. So began Koda’s Hope. Relying on the kindness and generosity of others, the Taylor family began their fundraising journey. Little by little, donations came in and Koda’s family was able to pay for his surgery.

Then, in July of 2015, Koda and Dr. Branter met again. Koda was placed under anesthesia and brought into the very first purpose-built interventional radiology suite for animals on the West Coast. From there, Dr. Branter used fluoroscopy, a live video x-ray, to perform the PTCE, where a catheter is inserted into the jugular and is guided it all the way down to the liver. Dr. Branter then used an angiogram, which is an x-ray test that uses a special dye and fluoroscopy to take pictures of the blood flow in an artery or a vein, to confirm the size and location of the shunt.

Once the location was confirmed, Dr. Branter placed a caval stent, then brought six embolic coils down to Koda’s liver and placed them at the location of the shunt entry into the cava to increase the pressure around it and divert blood flow back into the liver.

Koda had very little recovery time as opposed to a traditional surgery.
In just a few hours, Dr. Branter had successfully corrected the liver shunt and Koda was waking up from surgery. Being that the PTCE is a minimally invasive procedure, Koda had very little recovery time as opposed to a traditional surgery, and was able to go home in just two days. Of course, with any surgery, there are precautions one needs to take—Koda wasn’t allowed to have any leashes or collars around his neck and was ordered to kick back and relax for the first few days home to ensure his body healed properly.

Everything went well and Koda healed beautifully. He now has a long, bright future full of loving his family and raising awareness for liver shunt in dogs like himself.

Keywords: liver shunt, congenital liver shunt, percutaneous transjugular coil embolization, minimally invasive treatment of liver shunts, caval stent, liver failure, elevated liver enzymes

Kiki’s Nephrolithotomy: Big Word, Little Dog.

Surgically Assisted Nephrolithotomy

What to do with complicated kidney stones in dogs? Laser them out!

Kiki is a beautiful four-year-old female spayed Japanese Chin who was kindly rescued with pre-existing kidney issues and an abnormal eye. Kiki repeatedly saw Dr. Erinne Branter, head of our interventional radiology department, for kidney stones and kidney disease. The kidney stones were not able to be medically dissolved and as a result, Kiki kept having painful urinary tract infections.

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Often, kidney stones can be left alone if they are not causing any issues, but Kiki had developed stones causing obstructions to her kidneys by blocking the ureter, the tube that brings urine to the bladder from the kidney.

Dr. Branter discussed options to remove the kidney stone with Kiki’s owners—shockwave lithotripsy from outside the body, lasering the stone in the kidney in a minimally invasive way, or a surgery where the kidney is cut open to remove the stone.

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Kiki’s owners opted to remove the stone with a nephrolithotomy, a minimally-invasive procedure to remove stones from the kidney by using a small catheter through a small incision, and then place a ureteral stent. This made sure the kidney had very little damage and that all the stones were able to be removed. We used a combination of minimally invasive approaches to the kidney to reduce damage to kidney tissue. We then used an endoscope and a laser to break up the stone and make stone fragments that were small enough to be removed without damaging the kidneys.

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This entire process is called a nephrolithotomy (kidney stone removal) and is the standard of care for humans with complicated kidney stones. Although few have been done in veterinary medicine, Kiki was able to go through the procedure without any issues and is recovering very well with no negative changes in her kidney values or function. We are thrilled to report that little Kiki is now stone free! Many pet owners do not know that their pets can suffer from many of the same illnesses that humans do. Unfortunately, pets suffering from illness can also experience the same pain and discomfort as we do, though they may be better at hiding it.

If you suspect your pet is experiencing urinary issues, contact your primary veterinarian right away.

Key words for pet owners:

  • Kidney stones- A hard mass formed in the kidneys
  • Lithotripsy- A treatment, typically using ultrasound shock waves, by which a kidney stone or other calculus is broken into small particles that can be passed out by the body
  • Nephrolithotomy- A minimally-invasive procedure to remove stones from the kidney by a small puncture wound (up to about 1 cm) through the skin
  • Stone retrieval- A process in which a doctor retrieves and removes stones from within the body
  • Ureteral stent- A thin, flexible tube threaded into the ureter
  • Ureteral stones- Stones that form within the ureter
  • Urinary obstruction- An obstruction that occurs within the urinary tract. Obstructions in the urinary tract cause distension of the walls of the bladder, ureter, or renal pelvis, depending on the location of the obstruction
  • Urinary stones- Stones that form within the urinary tract
  • Urinary tract infection- An infection in any part of the urinary system, the kidneys, bladder, or urethra
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No Stone Left Unturned…

Ozzie-IR

Ozzie is a beautiful 12 year old Himalayan cat who was referred to Dr. Erinne Branter at ACCESS Specialty Animal Hospital, Los Angeles, after being hospitalized for several days at his primary veterinarian’s office with a right ureteral obstruction. Ureteral obstructions are blockages that prohibit urine to drain from the bladder and can be caused by blood clots, mucus, crystals, strictures, tumors, or in Ozzie’s case, stones. Blockages are no walk in the park for any patient—animal or human— but can be deadly to dogs and cats. Untreated, a blockage can cause death due to complete kidney shut down.

Typically, a stent (tube that links the kidney to the bladder) can be placed to help a patient’s body pass the urine and stones. Ozzie had a stent implanted previously, which worked well for him for some time. Unfortunately, some patients are simply prone to re-obstruction, and in Ozzie’s case this called for a different approach.

Ozzie-fluoro-image
Dr. Branter, the head of our Interventional Radiology Department, consulted with Ozzie’s owners, and it was decided that a subcutaneous ureteral bypass, or SUB, would be placed to help Ozzie pass urine.

(Click on image for larger view.)

The SUB works as a secondary ureter, having one end of a small catheter implanted into the kidney and leading to the port, which rests under the skin, and connects to the end of the catheter which leads to the bladder. The port makes it possible for a veterinarian to flush the catheters to obtain urine samples for testing; while the catheter acts as a filter for the urine, making it possible for the fluid to pass through successfully.

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Dr. Branter performed the SUB placement alongside Dr. Kim Carey, an ACCESS surgeon. With two veterinary technicians to assist and another to monitor the anesthesia, Ozzie was in good hands. The sub was placed successfully and they also were able to extract fat cells to culture stem cells. Ozzie’s stem cells will be used to help his kidney function in the future. It is not uncommon for cats to stop eating while they are under stress from being out of their normal environment, so Ozzie also had an esophageal feeding tube, or e-tube, temporarily placed to help him during his recovery process. After recovering well from anesthesia, Ozzie stayed in our hospital for a few days to be monitored after his surgery. It’s safe to say that Ozzie stole all of our hearts here during his stay, and we are so happy to have been able to help him.

Ozzie’s case is not uncommon, though it may be hard for some owners to recognize the signs of an emergency with their cat. Symptoms of ureteral blockages may include change in appetite and general signs of lethargy, vomiting, or reduced appetite. These are not typical “urinary” signs as seen with bladder or urethral issues, but they should be evaluated by a doctor.

If you think your cat may be blocked, call your primary veterinarian immediately. Additionally, if your cat has elevated kidney values, please have him or her checked with an ultrasound of the kidneys. This is very important as you can significantly improve kidney function by addressing ureteral obstructions.

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Shannon Brown
Marketing Coordinator | ACCESS Specialty Animal Hospitals

Very rare in dogs…

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Blondie is a two year old mixed breed dog who was rescued off of the streets by the Hope for Paws Rescue. Blondie had been surviving between two lanes of a main highway and it took hours to rescue her. Soon after, she was taken to a neighborhood veterinarian for an exam and to be spayed. During her spay, the doctor found something unusual. Blondie seemed to have two vaginal openings. Her veterinarian, Dr. Erin Wilson from the Veterinary Care Center referred her to Dr. Erinne Branter, (below) the head of our Interventional Radiology department, who performed a cystoscopy in our interventional radiology suite. A cystoscopy is a diagnostic tool used to see inside lower urinary tract (urethra and bladder). Unlike many other imaging tools, the cystoscope is placed directly inside the body, allowing the doctor to see inside the organ with a small camera.

Blondie was placed under anesthesia, with one technician assigned to monitor her vitals, and another to assist the doctor. Dr. Branter used the cystoscopy to examine and confirm that Blondie does in fact have dual vaginal openings. Blondie has one opening that is normal from the outside (vulva is normal) but houses a blind ended sac. She also has a second opening that is abnormal from the outside but once the scope evaluated the orifice the rest of the anatomy (urethra and vagina) was completely normal. She is urinating like a normal dog and does not seem to have any adverse consequences to her abnormal anatomy (given she is now spayed and will not be reproducing). Blondie is in good health, and does not need any medical intervention for her condition. This case was an interesting one for Dr. Branter, as dual vagina openings are very rare in dogs, and not previously documented in veterinary medicine.

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Sophie now enjoys a breath of fresh air…

Sophie is a one year old domestic short hair cat who was adopted in January from a local shelter. A few weeks after arriving at her new home, she began to hack.

It sounded almost as if she was trying to pass a hairball, but something wasn’t quite right, so it was off to see Dr. Erinne Branter, an Internal Medicine Specialist at ACCESS Specialty Animal Hospital – Los Angeles.

A few tests and a radiograph later and Sophie was diagnosed with Feline Asthma, and recommended to ‘use an inhaler’ twice a day. What a difference: Sophie is now able to run, jump, roll-around and dream of what cat’s dream about without the hindrances she had to endure.

Thank you Dr. Branter.

Sophie

NOTE: Sophie’s owner is none other than Shannon Brown, our high-energy, always ready to serve others, ACCESS Hospital Representative.

Listen to Dr. Branter on Pet Life Radio…

There is an adage attributed to surgeons – a chance to cut is a chance to cure. For a time, this statement was probably true. A doctor had a limited number of ways of seeing what was going on inside of a body and correcting a problem. Now humans and animals are benefiting from myriad of minimally invasive procedures that can diagnose, treat and often cure conditions where previously a scalpel could never go.

Erinne Branter is a board certified veterinary internist at Advanced Critical Care, Emergency and Specialty Services in Los Angeles who has harnessed the magic of interventional radiology and endoscopy. – Bernadine D. Cruz, D.V.M., Host on Pet Life Radio. (www.petliferadio.com)

Listen to the full interview/broadcast by clicking on the image below.

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Tel: (310) 320-8300 - Fax: (424) 293-7254

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