New perspectives on the development of extrahepatic portosystemic shunts

In this essay we use clinical evidence and knowledge of anatomy to examine the relationship between blood flow and formation of congenital extrahepatic portosystemic shunts in dogs and cats. First we report on the clinical findings in a series of 50 dogs and 10 cats and then systematically review peer-reviewed data on the detailed anatomy of shunts in dogs and cats. In dogs four types of shunt: spleno-caval, left gastro-phrenic, left gastro-azygos and those involving the right gastric vein account for 94% of extrahepatic shunts. Cats also exhibit four types of shunt: spleno-caval, left gastrophrenic, left gastro-caval and left gastro-azygos, and the first three of these account for 92% shunts in this species. Our findings lead us to propose that preferential blood flow influences the subsequent formation of one of a number of defined and consistent congenital extrahepatic portosystemic shunts in dogs and cats.