Today's Veterinary Practice

TVP_JUL-AUG2018

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PEER REVIEWED 62 JULY/AUGUST 2018 todaysveterinarypractice.com VASCULAR ABNORMALITIES Thromboembolic Disease Thromboembolic disease can affect any of the intraabdominal vessels and is caused by a hypercoagulable state ( TABLE 2 ). 1,3–11 Ultrasonographically, chronic thrombi appear as echogenic tissue within the lumen of the vessel, causing partial or a complete obstruction of visualized blood flow ( FIGURE 6 ). Acutely, thrombi can be difficult to visualize as they are anechoic. If thrombi are suspected, color, power, and pulsed-wave Doppler interrogation is recommended, and any lesion should be confirmed by imaging in both long- and short-axis planes. Animals presenting in a hypercoagulable state may have slow blood flow that can be recognized before thrombus formation. On grayscale images, this can appear as echogenic "smoke" within the vessels, which is likely due to spontaneous agglutination of erythrocytes that increases the blood backscatter and echogenicity. Thorough evaluation of thromboembolism includes assessment for the following 12 : 1. Acute thrombi (using color and pulsed-wave Doppler) 2. Extent and location of visible thrombi (using color Doppler for evaluation of collateral circulation) 3. Peripheral blood flow (using color Doppler) 4. Evidence of neoplasia in the region 5. Sequelae of thrombosis (e.g., ischemia of distal structures/organs, evaluated using color Doppler; ascites from portal vein thrombosis) TABLE 2 Selected Thrombotic Risk Factors in Dogs and Cats 1,3–5 DOGS CATS PATIENT DISEASES AND CONDITIONS Immune-mediated hemolytic anemia Immune-mediated hemolytic anemia Sepsis Sepsis Neoplasia 6 Neoplasia 6 Cardiovascular disease (eg, cardiomyopathy, heartworm disease) 7,8 Cardiovascular disease (eg, cardiomyopathy, heartworm disease) 7,8 Pancreatitis Pancreatitis Glomerular disease (protein-losing nephropathy) 9 Glomerular disease (protein-losing nephropathy) 9 Cardiac disease (eg, endocarditis 10 ) Protein-losing enteropathy Hyperadrenocorticism (Cushing's disease or syndrome) Hepatic lipidosis Disseminated intravascular coagulopathy 9 Feline infectious peritonitis Amyloidosis Pneumonia Hypothyroidism Encephalitis Blastomycosis 11 Steroid administration Trauma TREATMENTS Intravenous catheter placement Steroid administration Recent surgery Cytotoxic drugs Blood transfusion Total hip implant

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