Ligation of the ipsilateral common carotid artery and topical treatment for the prevention of epistaxis from guttural pouch mycosis in horses

Abstract

The objective of the study was to evaluate the effect of ligation of the ipsilateral common carotid artery (CCA) combined with various antimycotic treatments for the prevention of epistaxis in horses with guttural pouch mycosis. For each case, ipsilateral ligation of the CCA was performed, followed by application of various topical medications under endoscopic guidance. Frequency and number of treatments, outcome and recurrence of haemorrhage were retrospectively recorded. Twenty-four horses were included. Topical medication was administered by detachment of the diphtheric membrane and spraying (n=16) or by intralesional injection directly in the plaques using a transendoscopic needle (n=8). Epistaxis recurred in five horses (20.8 per cent), causing death of four horses (16.6 per cent). The mean number of treatments was 6.3±4.0 (range 2-14) for all topical treatments. Ligation of the ipsilateral CCA and topical medication carries a fair prognosis for avoidance of recurrent episodes of epistaxis, but fatal haemorrhage can occur. Removal of the fungal plaque and topical treatment of the underlying lesion appeared to speed up resolution of the mycotic mucosal lesions. The described technique is a salvage procedure when financial or technical constraints prevent the use of transarterial catheter occlusion techniques.

Challenges associated with the diagnosis and management of guttural pouch epistaxis in equids

“…Meanwhile we should stop treating horses with multiple antifungal treatments as has been recently proposed (Cousty et al . ) especially if no proper occlusion technique has been performed. These multiple treatments, administered numerous times, have not proved successful while increasing the overall cost and do not prevent a fatal haemorrhage.…”

Diagnosis of Aspergillosis in Horses

“…To the best of our knowledge, no comprehensive data on the prevalence of GPM has been published. During the last decade, GPM occurrences are mainly reported by the results of cluster case series [ 5 , 6 , 7 , 8 ]. The rare equine invasive pulmonary aspergillosis (IPA) has almost 100% mortality [ 9 , 10 ].…”

Salpingopharyngeal fistula as a treatment for guttural pouch mycosis in seven horses

“…Systemically, treatments with thiabendazole [2,4], itraconazole [5,6] and iodide [7] have been described. Topical treatment of GPM with a range of topical medications can be found in the literature, but their efficacy is not well supported [6,[8][9][10][11][12][13].…”

“…Beyond preventing fatal haemorrhage, obstructing blood flow through these major vessels often results in inhibition of fungal growth by an unknown mechanism [2,14]. Decreased blood flow through the target vessel can be achieved using ligation, balloon tipped catheter placement or transarterial coil embolisation [7,8,11,[15][16][17][18][19][20][21]. These procedures do not directly address the potential for neurological disease, have their own risk of complications, and can be cost prohibitive.…”