Balloon catheter occlusion of the maxillary, internal, and external carotid arteries in standing horses

Abstract

Objective: To assess the feasibility of balloon catheter occlusion of the internal carotid artery (ICA), external carotid artery (ECA), and maxillary artery (MA) in standing horses. Study design: Experimental and clinical cases series. Animals: Eight healthy horses (phase 1) and 11 clinical cases (phase 2). Methods: Occlusions were performed on standing horses under sedation and local anesthesia. In phase 1, four horses underwent bilateral ICA balloon catheter occlusion, and four horses underwent balloon catheter occlusion of the ECA and MA. In phase 2, horses were treated by occlusion of ICA (n = 7), ECA (n = 2), or ECA and ICA (n = 2). Results: Internal carotid artery occlusion was successful in seven of eight and seven of nine arteries in phases 1 and 2, respectively. The procedures lasted 53 and 50 minutes, respectively, and catheters were inserted over 13 ± 0.7 cm (mean ± SD). External carotid artery occlusion was successful in seven of seven and four of four arteries in phases 1 and 2, respectively, with mean durations of 31 and 26 minutes, respectively, and a mean distance of catheter insertion of 11.9 cm. Maxillary artery occlusion was successful in five of seven arteries (phase 1), with a mean surgical duration of 47 minutes and a mean distance of catheter insertion of 42.8 cm. Conclusion: Balloon catheter occlusion of the ICA, ECA, and MA was achieved in most standing horses. Clinical significance: Balloon catheter occlusion in standing horses provides an alternative to prevent or treat hemorrhage related to guttural pouch mycosis, particularly in horses in which general anesthesia might pose a risk. 1 | INTRODUCTION Guttural pouch mycosis is a rare disease of the horse without apparent age, sex, and breed predisposition. 1,2 Hemorrhage related to guttural pouch mycosis is a life-threatening pathology commonly treated surgically by arterial occlusion, which is performed with ligation, embolization, or both. Various materials have been described for vascular embolization, such as balloon tipped catheter, 1,3,4 detachable selfsealing latex balloon, 5 transarterial coil, 6 or nitinol plug. 7 Unlike coil insertion, 8,9 balloon catheter occlusion

Laryngeal tie‐forward in standing sedated horses

“…In addition to the risk of prosthesis failure, it is well recognized that GA associated morbidity and mortality is higher in horses than other domestic species 17,18 . With this in mind, recent decades have seen a move towards application of equine surgical techniques being performed in standing sedated horses where possible 19–24 …”

Seizures and prolonged recovery from general anaesthesia in a horse with guttural pouch mycosis undergoing bilateral arterial coil embolisation

“…Guttural pouch mycosis is an uncommon fungal infection of the guttural pouches affecting horses of all breeds and ages. Clinical signs, such as epistaxis, dysphagia and neurological symptoms, often occur when submucosal arteries or nerves are infiltrated and can become life threatening if left untreated 1–3 . Therefore, surgical occlusion of the affected vessels is indicated in horses with clinical signs and endoscopic findings associated with mycotic growth.…”

“…Clinical signs, such as epistaxis, dysphagia and neurological symptoms, often occur when submucosal arteries or nerves are infiltrated and can become life threatening if left untreated. [1][2][3] Therefore, surgical occlusion of the affected vessels is indicated in horses with clinical signs and endoscopic findings associated with mycotic growth. Although various surgical approaches have been described in horses for vascular embolisation with an overall good prognosis, 4 the vast majority of these approaches require general anaesthesia.…”

“…Although various surgical approaches have been described in horses for vascular embolisation with an overall good prognosis, 4 the vast majority of these approaches require general anaesthesia. 3,5,6 To date, general anaesthesia in horses is consistently associated with a significantly increased risk for morbidity and mortality when compared to other domestic veterinary species, despite the modernisation of anaesthetic techniques over the past years. [7][8][9] Recovery from anaesthesia is of vital importance in horses, with multiple studies noting an incidence of over 90% of anaesthesia-related complications becoming evident during this phase, 9 in which access to the horse is Hospital of the Vetsuisse Faculty Zurich for coil embolisation as treatment of guttural pouch mycosis.…”

“…Therefore, surgical occlusion of the affected vessels is indicated in horses with clinical signs and endoscopic findings associated with mycotic growth. Although various surgical approaches have been described in horses for vascular embolisation with an overall good prognosis, 4 the vast majority of these approaches require general anaesthesia 3,5,6 . To date, general anaesthesia in horses is consistently associated with a significantly increased risk for morbidity and mortality when compared to other domestic veterinary species, despite the modernisation of anaesthetic techniques over the past years 7–9 .…”