Surgery still better....

Retrospective review of outcome following medical management of a congenital portosystemic shunt in 10 cats

Victoria Lipscomb 1,✉, Flora Anghileri-Jarman 1, Samantha Taylor 2

Background
Congenital portosystemic shunt (CPSS) in cats can be managed medically or surgically. While surgical management is linked with better long-term outcomes in dogs, it poses higher risks for cats, including life-threatening post-operative complications. There is limited data on long-term outcomes of medical management in feline CPSS. This study aimed to describe survival, cause of death, clinical signs, and long-term quality of life (QoL) in cats managed medically for CPSS.

Methods
This was a retrospective case series involving 10 cats diagnosed with CPSS between 2008 and 2024 at two referral centers. Cats included had undergone medical management (modified diet, lactulose ± antibiotics) and had complete health-related QoL (HRQoL) questionnaire data provided by their owners. Medical records were used to extract signalment, clinical signs, treatment details, and reason for avoiding surgery. The HRQoL questionnaire assessed clinical signs, behavior, body condition, and survival outcomes. CPSS scores were derived based on clinical sign severity and frequency.

Results
All 10 cats showed persistent clinical signs while on medical management, most commonly neurological symptoms. The median CPSS score was 30/124 (range 13–57). QoL improved post-treatment (median QoL score increased from 3.5 to 7.5). Eight owners (80%) noted improved QoL and nine (90%) noted improved body condition. Despite this, 50% of cats were euthanized due to CPSS-related complications, while four cats remained alive at the time of the study. The overall median follow-up time was 26.5 months (range 8 months to 15 years). All cats were treated with lactulose and modified diets, but none received anti-seizure medication.

Limitations
The study’s retrospective design and small sample size limit generalizability. There was no control group, and owner-reported outcomes may be subject to recall or attention bias. Exclusion of cases that died early or did not require treatment could introduce selection bias. The variability in dietary regimens and the absence of standardized feeding protocols further limit conclusions on the impact of nutrition.

Conclusions
Medical management of CPSS in cats can improve QoL and extend survival, though all treated cats exhibited ongoing clinical signs and half died due to the shunt. Further research with larger, prospective cohorts and comparison groups (surgical and healthy cats) is needed. Investigating optimal dietary approaches, including highly digestible protein options, is also recommended.

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