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.
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